Top

World Journal of Surgery

Published in:

01-06-2019 | Gastric Fundoplication | Scientific Review

Anterior Dor or Posterior Toupet with Heller Myotomy for Achalasia Cardia: A Systematic Review and Meta-Analysis

Authors: Manjunath Siddaiah-Subramanya, Rossita Mohamad Yunus, Shahjahan Khan, Breda Memon, Muhammed Ashraf Memon

Published in: World Journal of Surgery | Issue 6/2019

Abstract

Background and Aims

Partial fundoplication is commonly performed in conjunction with Heller Myotomy. It is, however, controversial whether anterior Dor or posterior Toupet partial fundoplication is the antireflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures.

Material and Methods

A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, Google scholar and current contents for English language articles comparing Dor and Toupet fundoplication following HM between 1991 and 2018 was performed. The outcome variables analyzed included operating time, length of hospital stay (LOHS), overall complication rate, quality of life (QOL), postoperative reflux, residual postoperative dysphagia, treatment failure and reoperations. The meta-analysis was prepared in accordance with the PRISMA-P statement.

Results

Seven studies totaling 486 patients (Dor = 245, Toupet = 241) were analyzed. LOHS was significantly shorter for Toupet repair compared to Dor procedure (WMD 0.73, 95% CI 0.47 to 0.99; P < 0.0001). Furthermore, patients after Toupet experienced significantly better QOL than those after Dor (WMD 1.68, 95% CI 0.68 to 2.73, P < 0.001). All other variables showed comparable effects for these two procedures.

Conclusion

Our systematic review and meta-analysis revealed that Toupet fundoplication is superior to Dor in terms of LOHS and QOL following HM. For other variables such as postoperative reflux, postoperative dysphagia, complication rates and treatment failure, both Dor and Toupet fundoplication produced effective and equivalent results.

Available only for authorised users

Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A et al (2011) Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med 364(19):1807–1816. https://doi.org/10.1056/nejmoa1010502 CrossRefPubMed

Yaghoobi M, Mayrand S, Martel M, Roshan-Afshar I, Bijarchi R, Barkun A (2013) Laparoscopic Heller’s myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 78(3):468–475. https://doi.org/10.1016/j.gie.2013.03.1335 CrossRefPubMed

Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M (2008) Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 248(6):1023–1030. https://doi.org/10.1097/sla.0b013e318190a776 CrossRefPubMed

Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C et al (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 26(1):18–26. https://doi.org/10.1007/s00464-011-1822-y CrossRefPubMed

Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F et al (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249(1):45–57. https://doi.org/10.1097/sla.0b013e31818e43ab CrossRefPubMed

Richardson WS, Kennedy CI, Bolton JS (2006) Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia. Surg Endosc 20(12):1914–1918. https://doi.org/10.1007/s00464-006-0227-9 CrossRefPubMed

Falkenback D, Johansson J, Oberg S, Kjellin A, Wenner J, Zilling T et al (2003) Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus Off J Int Soc Dis Esophagus 16(4):284–290CrossRef

Hunter JG, Trus TL, Branum GD, Waring JP (1997) Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg 225(6):655–664CrossRefPubMedPubMedCentral

Oelschlager BK, Chang L, Pellegrini CA (2003) Improved outcome after extended gastric myotomy for achalasia. Arch Surg 138(5):490–495. https://doi.org/10.1001/archsurg.138.5.490 CrossRefPubMed

10.

Patti MG, Herbella FA (2010) Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type? J Gastrointest Surg 14(9):1453–1458. https://doi.org/10.1007/s11605-010-1188-9 CrossRefPubMed

11.

Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G et al (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248(6):986–993. https://doi.org/10.1097/sla.0b013e3181907bdd CrossRefPubMed

12.

Torres-Villalobos G, Coss-Adame E, Furuzawa-Carballeda J, Romero-Hernandez F, Blancas-Brena B, Torres-Landa S et al (2018) Dor versus Toupet fundoplication after laparoscopic Heller myotomy: long-term randomized controlled trial evaluated by high-resolution manometry. J Gastrointest Surg 22(1):13–22. https://doi.org/10.1007/s11605-017-3578-8 CrossRefPubMed

13.

Kumagai K, Kjellin A, Tsai JA, Thorell A, Granqvist S, Lundell L et al (2014) Toupet versus Dor as a procedure to prevent reflux after cardiomyotomy for achalasia: results of a randomised clinical trial. Int J Surg 12(7):673–680. https://doi.org/10.1016/j.ijsu.2014.05.077 CrossRefPubMed

14.

Kiudelis M, Kubiliute E, Sakalys E, Jonaitis L, Mickevicius A, Endzinas Z (2017) The choice of optimal antireflux procedure after laparoscopic cardiomyotomy: two decades of clinical experience in one center. Wideochir Inne Tech Maloinwazyjne 12(3):238–244. https://doi.org/10.5114/wiitm.2017.68547 CrossRefPubMedPubMedCentral

15.

Tomasko JM, Augustin T, Tran TT, Haluck RS, Rogers AM, Lyn-Sue JR(2014) Quality of life comparing dor and toupet after heller myotomy for achalasia. JSLS J Soc Laparoendosc Surg 18(3). Epub 2014/11/14. https://doi.org/10.4293/jsls.2014.00191. PubMed PMID: 25392612; PubMed Central PMCID: PMCPMC4154402

16.

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 Endosc 21(5):713–718. https://doi.org/10.1007/s00464-006-9165-9 CrossRefPubMed

17.

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (2000) Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Rev Esp Salud Publica 74(2):107–118CrossRefPubMed

18.

Hutton B, Catala-Lopez F, Moher D (2016) The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin (Barc) 147(6):262–266. https://doi.org/10.1016/j.medcli.2016.02.025 CrossRef

19.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12CrossRefPubMed

20.

Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. https://doi.org/10.1007/s10654-010-9491-z CrossRefPubMed

21.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13 CrossRefPubMedPubMedCentral

22.

Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186 CrossRefPubMed

23.

Wg C (1954) The combination of estimates from different experiments. Biometric 10:101–129CrossRef

24.

R. The R project for statistical computing 2018, July 02. Available from: https://www.r-project.org/

25.

Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD et al (2012) SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26(2):296–311. https://doi.org/10.1007/s00464-011-2017-2 CrossRefPubMed

26.

Eckardt AJ, Eckardt VF (2011) Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol 8(6):311–319. https://doi.org/10.1038/nrgastro.2011.68 CrossRefPubMed

27.

Vantrappen G, Hellemans J (1980) Treatment of achalasia and related motor disorders. Gastroenterology 79(1):144–154CrossRefPubMed

28.

Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanstrom LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140(9):827–833. https://doi.org/10.1001/archsurg.140.9.827 CrossRefPubMed

29.

Junghard O, Wiklund I (2008) Validation of a four-graded scale for severity of heartburn in patients with symptoms of gastroesophageal reflux disease. Value Health J Int Soc Pharmacoeconomics Outcomes Res 11(4):765–770. https://doi.org/10.1111/j.1524-4733.2007.00313.x CrossRef

30.

Torres-Villalobos G, Martin-Del-Campo LA (2013) Surgical treatment for achalasia of the esophagus: laparoscopic heller myotomy. Gastroenterol Res Pract 2013:708327. https://doi.org/10.1155/2013/708327 CrossRefPubMedPubMedCentral

31.

Clarke A (1996) Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change. Qual Health Care QHC 5(3):172–179CrossRefPubMed

32.

Velanovich V, Karmy-Jones R (1998) Measuring gastroesophageal reflux disease: relationship between the health-related quality of life score and physiologic parameters. Am Surg 64(7):649–653PubMed

33.

Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus Off J Int Soc Dis Esophagus 20(2):130–134. https://doi.org/10.1111/j.1442-2050.2007.00658.x CrossRef

Title: Anterior Dor or Posterior Toupet with Heller Myotomy for Achalasia Cardia: A Systematic Review and Meta-Analysis
Authors: Manjunath Siddaiah-Subramanya
Rossita Mohamad Yunus
Shahjahan Khan
Breda Memon
Muhammed Ashraf Memon
Publication date: 01-06-2019
Publisher: Springer International Publishing
Keywords: Gastric Fundoplication
Gastric Fundoplication
Dysphagia
Dysphagia
Achalasia
Dysphagia
Published in: World Journal of Surgery / Issue 6/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-04945-9

At a glance: The STEP trials

Springer Medicine

Anterior Dor or Posterior Toupet with Heller Myotomy for Achalasia Cardia: A Systematic Review and Meta-Analysis

Abstract

Background and Aims

Material and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and Aims

Material and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2019

Revisiting Laparoscopic Reconstruction for Billroth 1 Versus Billroth 2 Versus Roux-en-Y After Distal Gastrectomy: A Systematic Review and Meta-Analysis in the Modern Era

Minimally Invasive Parathyroidectomy without Intraoperative PTH Performed after Positive Ultrasonography as the only Diagnostic Method in Patients with Primary Hyperparathyroidism

Bradycardia During Laparoscopic Surgeries: A Retrospective Cohort Study

Association of Medicaid Expansion Policy with Outcomes in Homeless Patients Requiring Emergency General Surgery

Re: Evaluation of Parathyroid Glands with Indocyanine Green Fluorescence Angiography After Thyroidectomy

Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified