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Dor Vs Toupet Fundoplication After Laparoscopic Heller Myotomy: Long-Term Randomized Controlled Trial Evaluated by High-Resolution Manometry

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic Heller myotomy (LHM) with partial fundoplication is an effective treatment for achalasia. However, the type of fundoplication is still a subject of debate.

Aim

The aim of the study is to identify which partial fundoplication leads to better control of acid exposure, manometric parameters, and symptoms scores.

Methods

A randomized controlled trial was performed to compare Dor vs Toupet fundoplication after LHM. The preoperative diagnosis was made by high-resolution manometry (HRM), upper endoscopy, and barium esophagogram. Preoperative and postoperative symptoms were evaluated with Eckardt, GERD-HRQL, and EAT-10 questionnaires.

Results

Seventy-three patients were randomized, 38 underwent Dor and 35 Toupet. Baseline characteristics were similar between groups. Postoperative HRM showed that the integrated relaxation pressure (IRP) and basal lower esophageal sphincter (LES) pressure were similar at 6 and 24 months. The number of patients with abnormal acid exposure was significantly lower for Dor (6.9%) than that of Toupet (34.0%) at 6 months, but it was not different at 12 or 24 months. No differences were found in postoperative symptom scores at 1, 6, or 24 months.

Conclusion

There were no differences in symptom scores or HRM between fundoplications in the long term. A higher percentage of abnormal 24-h pH test were found for the Toupet group, with no difference in the long term.

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Author information

Authors and Affiliations

  1. Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col Belisario Domínguez, Sección XVI, Alcaldía Tlalpan, 14080, Mexico City, Mexico

    Gonzalo Torres-Villalobos

  2. Department of Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col Belisario Domínguez, Sección XVI, Alcaldía Tlalpan, 14080, Mexico City, Mexico

    Gonzalo Torres-Villalobos, Fernanda Romero-Hernández, Blanca Blancas-Breña, Samuel Torres-Landa, Axel Palacios-Ramírez, Edgar Alejandro-Medrano, Axel Hernández-Ávila, Athenea Flores-Najera, Cecilia Ramírez Angulo & Angélica Rodríguez-Garcés

  3. Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col Belisario Domínguez, Sección XVI, Alcaldía Tlalpan, 14080, Mexico City, Mexico

    Enrique Coss-Adame & Miguel Ángel Valdovinos

  4. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col Belisario Domínguez, Sección XVI, Alcaldía Tlalpan, 14080, Mexico City, Mexico

    Janette Furuzawa-Carballeda

  5. Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col Belisario Domínguez, Sección XVI, Alcaldía Tlalpan, 14080, Mexico City, Mexico

    Lourdes Margarita Ávila Escobedo

Authors
  1. Gonzalo Torres-Villalobos
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  2. Enrique Coss-Adame
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  3. Janette Furuzawa-Carballeda
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  4. Fernanda Romero-Hernández
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  5. Blanca Blancas-Breña
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  6. Samuel Torres-Landa
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  7. Axel Palacios-Ramírez
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  8. Edgar Alejandro-Medrano
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  9. Axel Hernández-Ávila
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  10. Athenea Flores-Najera
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  11. Lourdes Margarita Ávila Escobedo
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  12. Cecilia Ramírez Angulo
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  13. Angélica Rodríguez-Garcés
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  14. Miguel Ángel Valdovinos
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Contributions

Study conception and design: Torres-Villalobos, Coss-Adame, Valdovinos.

Acquisition of data: Torres-Villalobos, Coss-Adame, Romero-Hernández, Blancas-Breña, Torres-Landa, Palacios-Ramírez, Alejandro-Medrano, Hernández-Ávila, Flores-Nájera, L Ávila, Valdovinos.

Analysis and interpretation of data: Torres-Villalobos, Coss-Adame, Furuzawa-Carballeda, Romero-Hernández, Blancas-Breña, Torres-Landa, Palacios-Ramírez, Alejandro-Medrano, Hernández-Ávila, Flores-Nájera, L Ávila, Valdovinos.

Drafting of manuscript: Torres-Villalobos, Coss-Adame, Furuzawa-Carballeda, Romero-Hernández, Torres-Landa, Valdovinos.

Critical Revision: Torres-Villalobos, Coss-Adame, Furuzawa-Carballeda, Romero-Hernández, Blancas-Breña, Torres-Landa, Palacios-Ramírez, Alejandro-Medrano, Hernández-Ávila, Flores-Nájera, L Ávila, Valdovinos.

Corresponding author

Correspondence to Gonzalo Torres-Villalobos.

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Disclosure

Dr. G. Torres Villalobos has received research grant support speaking/teaching for EndoStim ®.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Torres-Villalobos, G., Coss-Adame, E., Furuzawa-Carballeda, J. et al. Dor Vs Toupet Fundoplication After Laparoscopic Heller Myotomy: Long-Term Randomized Controlled Trial Evaluated by High-Resolution Manometry. J Gastrointest Surg 22, 13–22 (2018). https://doi.org/10.1007/s11605-017-3578-8

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  • DOI: https://doi.org/10.1007/s11605-017-3578-8

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