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Journal of Gastrointestinal Surgery

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01-04-2010 | Original Article

Significance of Limited Hiatal Dissection in Surgery for Achalasia

Authors: Aleksandar Petar Simić, Nebojša S. Radovanović, Ognjan M. Skrobić, Zoran J. Ražnatović, Predrag M. Peško

Published in: Journal of Gastrointestinal Surgery | Issue 4/2010

Abstract

Introduction

It is speculated that postoperative pathologic gastroesophageal reflux after Heller’s myotomy can be diminished if the lateral and posterior phrenoesophageal attachments are left intact. The aim of this study was to evaluate the effectiveness of limited hiatal dissection in patients operated due to achalasia.

Methods

Prospective, randomized, 3 years follow-up of 84 patients operated due to achalasia. In 26 patients, Heller–Dor with complete hiatal dissection was done (G1), limited hiatal dissection combined with myotomy and Dor’s procedure was performed in 36 patients (G2), and with Heller’s myotomy alone in 22 (G3). Stationary manometry and 24 h pH study were performed in regular postoperative intervals.

Results

Postoperatively, higher median values of lower esophageal sphincter resting pressures were marked in G2 and G3, while patients in G1 were presented with higher median values of pH acid score (p < 0.001). Abnormal DeMeester score 3 years after surgery was present in 23.1% of patients in G1 and 8.5% and 9.1% in G2 and G3 accordingly. There was no statistical difference between the groups concerning postoperative dysphagia recurrence.

Conclusion

Indicating further long-term studies, 3 years after the operation limited hiatal dissection compared to complete obtains better reflux control in achalasia patients, regardless of Dor’s fundoplication.

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Title: Significance of Limited Hiatal Dissection in Surgery for Achalasia
Authors: Aleksandar Petar Simić
Nebojša S. Radovanović
Ognjan M. Skrobić
Zoran J. Ražnatović
Predrag M. Peško
Publication date: 01-04-2010
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 4/2010
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-1135-9

At a glance: The STEP trials

Springer Medicine

Significance of Limited Hiatal Dissection in Surgery for Achalasia

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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