Skip to main content

Comparison of the Heller–Toupet procedure with the Heller–Dor procedure in patients who underwent laparoscopic surgery for achalasia

Surgery Today volume 44, pages 732–739 (2014)Cite this article

Abstract

Purpose

We compared the outcomes of Toupet fundoplication with those of Dor fundoplication in patients with achalasia who underwent laparoscopic Heller myotomy.

Methods

Seventy-two patients with achalasia and dysphagia underwent laparoscopic Heller myotomy with fundoplication performed by a single surgeon. Heller–Toupet fundoplication (HT) was performed in 30 patients, and Heller–Dor fundoplication (HD) was done in 42. The symptoms and esophageal function were retrospectively assessed in both groups.

Results

The dysphagia scores significantly decreased after both the HT and HD procedures, and did not differ significantly between them. The incidence of reflux symptoms was significantly higher after HT (26.7 %) than after HD (7.1 %). The lower esophageal sphincter (LES) resting pressure significantly decreased after both HT and HD. Upon endoscopic examination, the incidence of reflux esophagitis was significantly higher after HT (38.5 %) than after HD (8.8 %). During esophageal pH monitoring, the fraction time at pH <4 was similar in the patients who underwent HT and HD.

Conclusions

Laparoscopic Heller myotomy provided significant improvements in the dysphagia symptoms of achalasia patients, regardless of the type of fundoplication. The incidences of reflux symptoms and reflux esophagitis were higher after HT than after HD. However, the results of pH monitoring did not differ between the procedures.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Clouse RE, Staiano A. Manometric patterns using esophageal body and lower sphincter characteristics. Findings in 1013 patients. Dig Dis Sci. 1992;37:289–96.

    CAS  PubMed  Article  Google Scholar 

  2. Ferguson MK. Achalasia: current evaluation and therapy. Ann Thorac Surg. 1991;52:336–42.

    CAS  PubMed  Article  Google Scholar 

  3. Campos GM, Vittinghoff E, Rabl C, Tanaka M, Gadenstatter M, Lin F, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45–57.

    PubMed  Article  Google Scholar 

  4. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb. 1991;36:152–4.

    CAS  PubMed  Google Scholar 

  5. Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD. Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery. 2009;146:826–31 (discussion 831–23).

    PubMed  Article  Google Scholar 

  6. Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007;21:713–8.

    CAS  PubMed  Article  Google Scholar 

  7. Ancona E, Anselmino M, Zaninotto G, Costantini M, Rossi M, Bonavinal L, et al. Esophageal achalasia: laparoscopic versus conventional open Heller–Dor operation. Am J Surg. 1995;170:265–70.

    CAS  PubMed  Article  Google Scholar 

  8. Yano F, Omura N, Tsuboi K, Hoshino M, Yamamoto SR, Kashiwagi H, Yanaga K. Single-incision laparoscopic Heller myotomy and Dor fundoplication for achalasia: report of a case. Surg Today. 2012;42:299–302.

    PubMed  Article  Google Scholar 

  9. Patti MG, Herbella FA. Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type? J Gastrointest Surg. 2011;14:1453–8.

    Article  Google Scholar 

  10. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12.

    PubMed Central  PubMed  Article  Google Scholar 

  11. Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg. 1997;225:655–64.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  12. Mattioli S, Ruffato A, Lugaresi M, Pilotti V, Aramini B, D’Ovidio F. Long-term results of the Heller–Dor operation with intraoperative manometry for the treatment of esophageal achalasia. J Thorac Cardiovasc Surg. 2010;140:962–9.

    PubMed  Article  Google Scholar 

  13. Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, et al. Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg. 2001;136:870–7.

    CAS  PubMed  Article  Google Scholar 

  14. Wills VL, Hunt DR. Functional outcome after Heller myotomy and fundoplication for achalasia. J Gastrointest Surg. 2001;5:408–13.

    CAS  PubMed  Article  Google Scholar 

  15. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg. 2008;248:1023–30.

    PubMed  Article  Google Scholar 

  16. Frantzides CT, Moore RE, Carlson MA, Madan AK, Zografakis JG, Keshavarzian A, et al. Minimally invasive surgery for achalasia: a 10-year experience. J Gastrointest Surg. 2004;8:18–23.

    PubMed  Article  Google Scholar 

  17. Arain MA, Peters JH, Tamhankar AP, Portal G, Almogy G, DeMeester SR, et al. Preoperative lower esophageal sphincter pressure affects outcome of laparoscopic esophageal myotomy for achalasia. J Gastrointest Surg. 2004;8:328–34.

    PubMed  Article  Google Scholar 

  18. Katada N, Sakuramoto S, Kobayashi N, Futawatari N, Kuroyama S, Kikuchi S, et al. Laparoscopic Heller myotomy with Toupet fundoplication for achalasia straightens the esophagus and relieves dysphagia. Am J Surg. 2006;192:1–8.

    PubMed  Article  Google Scholar 

  19. Raiser F, Perdikis G, Hinder RA, Swanstrom LL, Filipi CJ, McBride PJ, et al. Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures. Arch Surg. 1996;131:593–7 (discussion 597–598).

    CAS  PubMed  Article  Google Scholar 

  20. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Gamiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  21. Mattioli S, Pilotti V, Felice V, Di Simone MP, D’Ovidio F, Gozzetti G. Intraoperative study on the relationship between the lower esophageal sphincter pressure and the muscular components of the gastro-esophageal junction in achalasic patients. Ann Surg. 1993;218:635–9.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  22. Rawlings A, Soper NJ, Oelschlager B, Swanstorom L, Matthews BD, Pellegrini C, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26:18–26.

    PubMed  Article  Google Scholar 

  23. Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974;62:325–32.

    CAS  PubMed  Google Scholar 

  24. Novais PA, Lemme EM. 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy. Aliment Pharmacol Ther. 2010;32:1257–65.

    CAS  PubMed  Article  Google Scholar 

Download references

Conflict of interest

None of the authors has any conflict of interest.

Author information

Affiliations

  1. Department of Surgery, Kitasato University School of Medicine, 2-1-1, Asamizodai, Minami-ku, Sagamihara, Kanagawa, 252-0380, Japan

    Natsuya Katada, Shinichi Sakuramoto, Keishi Yamashita, Kei Hosoda, Tomotaka Shibata, Hiromitsu Moriya, Shiro Kikuchi & Masahiko Watanabe

Authors
  1. Natsuya Katada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinichi Sakuramoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keishi Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kei Hosoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomotaka Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiromitsu Moriya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shiro Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masahiko Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natsuya Katada.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Katada, N., Sakuramoto, S., Yamashita, K. et al. Comparison of the Heller–Toupet procedure with the Heller–Dor procedure in patients who underwent laparoscopic surgery for achalasia. Surg Today 44, 732–739 (2014). https://doi.org/10.1007/s00595-013-0640-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0640-3

Keywords

  • Achalasia
  • Laparoscopic surgery
  • Fundoplication
  • Dor
  • Toupet