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Laparoscopic Heller Myotomy with Dor Fundoplication: An Operation that has Withstood the Test of Time

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Abstract

Background

Achalasia is a primary esophageal motility disorder characterized by aperistalsis and defective relaxation of the lower esophageal sphincter in response to swallowing. Patients’ symptoms include dysphagia, regurgitation, weight loss, chest pain and aspiration. The disease is idiopathic, and the goal of treatment is to eliminate the resistance determined by the abnormal lower esophageal sphincter, therefore allowing passage of the ingested food from the esophagus into the stomach. Three effective treatment modalities are available today—pneumatic dilatation, peroral endoscopic myotomy, and laparoscopic Heller myotomy with a partial fundoplication.

Methods

We described the technique to perform a laparoscopic Heller myotomy and a Dor fundoplication.

Results

Five steps to perform a laparoscopic Heller myotomy and a Dor fundoplication were described.

Conclusions

The surgical approach is favored in many centers as it is very effective in relieving symptoms, while avoiding pathologic gastroesophageal reflux in most patients.

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References

  1. Boeckxstaens GE, Annese V, des Varannes SB et al (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. European Achalasia Trial Investigators. N Engl J Med 364:1807–1816

    Article  CAS  PubMed  Google Scholar 

  2. Werner YB, Hakanson B, Martinek J et al (2019) Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 381:2219–2229

    Article  PubMed  Google Scholar 

  3. Jones EL, Meara MP, Schwartz JS, Hazey JW (2016) Gastroesophageal reflux symptoms do not correlate with objective pH testing after. Surg Endosc 30:4321–4328

    Article  Google Scholar 

  4. Kumbhari V, Familiari P, Bjerregaard NC et al (2017) Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-controlled study. Endoscopy 49:634–642

    Article  PubMed  Google Scholar 

  5. Sanaka MR, Thota PN, Parikh MP et al (2019) Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia. Surg Endosc 32:2284–2292

    Article  Google Scholar 

  6. The JL, Tham HY, Sen Soh AY et al (2021) Gastroesophageal reflux disease after peroral endoscopic myotomy. Surg Endosc. https://doi.org/10.1007/s00464-021-08644

    Article  Google Scholar 

  7. Schlottmann F, Luckett DJ, Fine J, Shaheen N, Patti MG (2018) Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia. A systematic review and meta-analysis. Ann Surg 267:451–460

    Article  PubMed  Google Scholar 

  8. Patti MG, Arcerito M, De Pinto M et al (1998) Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg 2:561–566

    Article  CAS  PubMed  Google Scholar 

  9. Richards WO, Torquati A, Holzman Md et al (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia. A prospective randomized double-blind clinical trial. Ann Surg 240:405–415

    Article  PubMed  PubMed Central  Google Scholar 

  10. Werner YB, Costamagna G, Swanstrom LL et al (2016) Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 65:899–906

    Article  CAS  PubMed  Google Scholar 

  11. Ichkhanian Y, Benias P, Khashab MA (2019) Case of early Barrett cancer following peroral endoscopic myotomy. Gut 68:2107–2110

    Article  CAS  PubMed  Google Scholar 

  12. Nurczyk K, Farrell TM, Patti MG (2020) Antireflux surgery for gastroesophageal reflux refractory to medical treatment after peroral endoscopic myotomy. J Laparoendoc Adv Surg Tech A 30:612–614

    Article  Google Scholar 

  13. Borraez B, Patti MG, Fisichella PM, Patti MG (2015) Atlas of esophageal surgery. Chapter 9: Operation for achalasia. Springer International Publishing, Berlin

    Google Scholar 

  14. Wright AS, Williams CW, Pellegrini CA, Oelschlager BK (2007) Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endoc 21:713–718

    Article  CAS  Google Scholar 

  15. Inaba CS, Wright AS (2020) Laparoscopic Heller myotomy and Toupet fundoplication for achalasia. J Laparoendosc Adv Surg Tech A 30:630–634

    Article  PubMed  Google Scholar 

  16. Zaninotto G, Costantini M, Rizzetto C et al (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single center experience. Ann Surg 248:986–993

    Article  PubMed  Google Scholar 

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Correspondence to Marco G. Patti.

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Orlow, R., Herbella, F.A. & Patti, M.G. Laparoscopic Heller Myotomy with Dor Fundoplication: An Operation that has Withstood the Test of Time. World J Surg 46, 1531–1534 (2022). https://doi.org/10.1007/s00268-022-06580-3

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  • DOI: https://doi.org/10.1007/s00268-022-06580-3

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