Clinical Outcomes of Standard vs. Extended Heller Myotomy with Nissen and Dor Fundoplication: A Comprehensive Study in the Surgical Management of Achalasia
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Tarih
2025-01-25
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Springer Science and Business Media LLC
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and loss of peristalsis. Laparoscopic Heller myotomy (LHM) combined with anti-reflux surgery is considered the gold standard for long-term treatment. However, there is ongoing debate regarding the optimal myotomy length and choice of anti-reflux procedure. This retrospective study analyzed 49 achalasia patients treated between 2016 and 2023 using two Heller myotomy techniques (standard vs. extended) combined with two anti-reflux procedures (Nissen vs. Dor fundoplication). Data on demographic characteristics, surgical details, complications, and postoperative outcomes were collected. Patients were followed up to assess dysphagia, Gastroesophageal reflux disease (GERD) symptoms, recurrence rates, and satisfaction levels. Extended myotomy significantly reduced recurrence rates compared to standard myotomy (0% vs. 22.2%, p = 0.014). Nissen fundoplication was associated with fewer GERD symptoms than Dor fundoplication (p = 0.01). Patient satisfaction was highest in the extended myotomy with the Nissen fundoplication group (p = 0.009). No mortality occurred, and complications were minimal. Postoperative timed water-soluble contrast esophagograms showed effective esophageal emptying in 91.8% of patients. Relapse cases were successfully managed with additional interventions. Extended myotomy with Nissen fundoplication provides superior outcomes in achalasia treatment, including lower recurrence rates, fewer GERD symptoms, and higher patient satisfaction. These findings highlight the importance of myotomy length and anti-reflux procedure selection for optimizing treatment outcomes. Further studies are needed to validate these results and establish standardized protocols.
Açıklama
Anahtar Kelimeler
Achalasia, Dor fundoplication, Esophageal motility disorder, Extended myotomy, Heller myotomy, Nissen fundoplication
Kaynak
Indian Journal of Surgery
WoS Q Değeri
Q4
Scopus Q Değeri
Q4
Cilt
Sayı
Künye
Yetişir, F., Çelik, M. E., Taşkın, Y. E., Kurt, Ö., & Tiken, R. (2025). Clinical Outcomes of Standard vs. Extended Heller Myotomy with Nissen and Dor Fundoplication: A Comprehensive Study in the Surgical Management of Achalasia. Indian Journal of Surgery, 1-8.
