PMID- 12407357
OWN - NLM
STAT- MEDLINE
DCOM- 20021204
LR  - 20190916
IS  - 0039-6060 (Print)
IS  - 0039-6060 (Linking)
VI  - 132
IP  - 4
DP  - 2002 Oct
TI  - Floppy Dor fundoplication after esophagocardiomyotomy for achalasia.
PG  - 716-22; discussion 722-3
AB  - BACKGROUND: When esophagocardiomyotomy (ECM) is performed for achalasia, a 
      complementary antireflux procedure of the surgeon's choice is usually performed 
      to minimize postoperative gastroesophageal reflux. This retrospective analysis 
      describes patients after laparoscopic ECM, most of whom had a modified Dor 
      fundoplication. METHODS: Between 1994 and 2001, 81 patients with achalasia of the 
      esophagus had laparoscopic ECM. We have previously described the use of 
      intraoperative endoscopy to verify completion of ECM in a cohort of 48 patients 
      who had either Toupet fundoplication (n = 25) or floppy Dor fundoplication (n = 
      23). Since then floppy Dor fundoplication has been the preferred antireflux 
      procedure for ease of performance and safety reasons. This article describes the 
      floppy Dor fundoplication as we have performed it since 1997, anchoring the wrap 
      to both crura of the hiatus. In addition, the anterior gastric wall is sutured to 
      the anterior rim of the esophageal hiatus, avoiding creation of the 
      paraesophageal hernia that occurs if the gastric wall abuts the entire the length 
      of a long ECM. RESULTS: During the 1- to 70-month follow up period (mean 45 
      months), patients who were symptomatic were evaluated by radiographic, 
      manometric, or endoscopic methods; pH studies were not done systematically. The 
      70% of patients who could be evaluated had postoperative quality of life and 
      symptom assessment interviews that revealed willingness to repeat the operation. 
      Overall satisfaction was high (8.4/10 where 10 is perfect); moderate dysphagia 
      was seen in 11 (16%) 3 to 16 months postoperatively, but patients reverted to a 
      satisfaction score of 8.2 after endoscopic dilation. Occasional heartburn was 
      present in 15 (26%) patients with regular, 5-use proton pump inhibitors (PPI), 
      including 1 with Barrett's esophagus. Others use these medications for gastric 
      disorders. No patient has had cancer of the esophagus develop, but endoscopic 
      surveillance has been inconstant. CONCLUSIONS: Swallowing was improved in 
      patients without sigmoid esophagus and overall satisfaction was high. New-onset 
      heartburn is an unpredictable problem that can be treated in most patients. 
      Endoscopic dilatation may be required at intervals after ECM-fundoplication for 
      bridging fibrosis at the cardia, but has not required reoperation, as a rule. 
      Laparoscopic ECM is an attractive operation for achalasia.
FAU - Donahue, Philip E
AU  - Donahue PE
AD  - Cook County Hospital, Rush University, and the University of Illinois at Chicago, 
      Chicago, Ill 60612, USA. phil@eolas.com
FAU - Horgan, Santiago
AU  - Horgan S
FAU - Liu, Katherine J-M
AU  - Liu KJ
FAU - Madura, James A
AU  - Madura JA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Cardiac Surgical Procedures
MH  - Child
MH  - Child, Preschool
MH  - Esophageal Achalasia/*surgery
MH  - Esophagus/surgery
MH  - Follow-Up Studies
MH  - Fundoplication/*methods
MH  - Humans
MH  - Middle Aged
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2002/10/31 04:00
MHDA- 2002/12/05 04:00
CRDT- 2002/10/31 04:00
PHST- 2002/10/31 04:00 [pubmed]
PHST- 2002/12/05 04:00 [medline]
PHST- 2002/10/31 04:00 [entrez]
AID - S0039606002001526 [pii]
AID - 10.1067/msy.2002.128557 [doi]
PST - ppublish
SO  - Surgery. 2002 Oct;132(4):716-22; discussion 722-3. doi: 10.1067/msy.2002.128557.