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L3. Anterior Fundoplication Decreases Esophageal Clearance in Patients Undergoing Laparoscopic Heller Myotomy for Achalasia
Christian Finley, Joanne Clifton, John Yee, Frank Tyers, Richard J Finley; Vancouver, BC, Canada
Objective:
Anterior fundoplication (AF) following laparoscopic Heller myotomy (LHM) for achalasia may prevent esophageal leaks and gastroesophageal reflux but cause dysphagia. The purpose of this study is to determine the effect of AF on esophageal leaks, nuclear esophageal clearance of liquid(EC),Van Trappen symptom scores (SS) for dysphagia, regurgitation, and heartburn (1=none; 2=once/week; 4=more severe/weight loss), and severe symptom frequency (Van Trappen Score = 3 or 4).
Methods:
Between 1995 and 2004, EC, SF and SS scores were compared in the preoperative and postoperative (2-12 mo) periods in 95 patients who underwent LHM for achalasia with (n=71) and without (n=24) AF.
Results:
There were no leaks or deaths in the study. LHM with AF decreased the frequency of postoperative dysphagia, regurgitation and heartburn (96% pre-op vs 6% post-op, 94% vs 3%, 58% vs 6%) (p=0.001). Without AF, the frequencies of dysphagia, regurgitation and heartburn (100% vs 0%, 83% vs 0%, 50% vs 4%) (p=0.001) also improved. LHM improved all symptom scores in both groups. There was a trend towards worse postoperative symptom scores of dysphagia (1.38+/-.64 vs 1.17+/-.38) p=0.06 and, regurgitation (1.17+/-.51 vs 1.04+/-.20) p=0.08 but not heartburn (1.29+/-.62 vs 1.53+/-.80) p= 0.185 in the AF group compared to the no AF group. LHM improved EC in the supine and upright positions in both groups (p=0.001). There was a statistically improved mean change EC (10 min upright) in the no AF group compared to the AF group(50.7%+/-30.8 vs 29.7%+/-30.2) p=0.004.
Conclusions:
In patients with achalasia, LHM with or without AF improves esophageal transit and the frequency and severity of dysphagia, heartburn and regurgitation in a safe manner. Patients without anterior fundoplication show statistically better upright esophageal clearance with a trend towards improved dysphagia and regurgitation scores when compared with the group who underwent anterior fundoplication.
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