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Surgical Endoscopy

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01-08-2015

Symptomatic outcome following laparoscopic Heller’s cardiomyotomy with Dor fundoplication versus laparoscopic Heller’s cardiomyotomy with angle of His accentuation: results of a randomized controlled trial

Authors: Pavithra Balakrishna, Rajinder Parshad, Jitender Rohila, Anoop Saraya, Govind Makharia, Raju Sharma

Published in: Surgical Endoscopy | Issue 8/2015

Abstract

Background

The type of anti-reflux procedure to be used as an adjunct to laparoscopic Heller’s cardiomyotomy (LHCM) in Achalasia cardia is controversial. We compared Angle of His accentuation and Dor fundoplication in a randomized controlled trial.

Methods

From May 2010 to October 2013, 62 patients undergoing LHCM were randomized to receive either Dor fundoplication (Dor group) or Angle of His accentuation (AOH group) as an anti-reflux procedure. Symptomatic outcome was evaluated using modified Mellow and Pinkas scale for dysphagia and modified DeMeester’s score for regurgitation and heartburn. Achalasia-specific quality-of-life (QOL) questionnaire was used to assess quality of life. The primary outcome was symptomatic relief and the secondary outcome was postoperative heartburn. Statistical analysis was done using SPSS software.

Results

All the procedures were completed laparoscopically with no mortality. Morbidity was similar in the two groups (6.4 %). Median operative time was higher in Dor group (170 vs 130 min). At a median follow-up of 21 months relief of dysphagia, regurgitation, and heartburn was seen in 87, 90.3, and 90.3 % patients in Dor group versus 93.5, 96.7, and 77.4 % in AOH group patients with significant improvement in symptom scores. Improvement was similar in both groups with no statistically significant difference in the symptom scores (p = 0.48 for dysphagia, p = 0.37 for regurgitation, and p = 0.19 for heartburn). The QOL improved in both groups [62.3 to 12.3 (p = 0.02) in Dor group and 63.9–13 (p = 0.02) in AOH group] with no statistically significant difference between the two groups (p = 0.96). There was no statistically significant difference in the postoperative heartburn between the two groups (p = 0.19).

Conclusion

Laparoscopic Heller's cardiomyotomy with either Angle of His accentuation or Dor fundoplication leads to similar improvement in symptoms and quality of life.

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Title: Symptomatic outcome following laparoscopic Heller’s cardiomyotomy with Dor fundoplication versus laparoscopic Heller’s cardiomyotomy with angle of His accentuation: results of a randomized controlled trial
Authors: Pavithra Balakrishna
Rajinder Parshad
Jitender Rohila
Anoop Saraya
Govind Makharia
Raju Sharma
Publication date: 01-08-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3958-z

At a glance: The STEP trials

Springer Medicine

Symptomatic outcome following laparoscopic Heller’s cardiomyotomy with Dor fundoplication versus laparoscopic Heller’s cardiomyotomy with angle of His accentuation: results of a randomized controlled trial

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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