Laparoscopic esophagomyotomy for achalasia: does anterior hemifundoplication affect clinical outcome?
OBJECTIVE
To determine whether the addition of anterior hemifundoplication to laparoscopic esophagomyotomy for achalasia yields better clinical outcomes than laparoscopic esophagomyotomy alone.


BACKGROUND
Although hemifundoplication may prevent gastroesophageal reflux after esophagomyotomy for achalasia, it may also lead to persistent dysphagia in these patients with esophageal aperistalsis.


METHODS
This is a retrospective study of 51 consecutive patients (mean age 47.5 +/- 12.6 years) who had laparoscopic esophagomyotomy for achalasia by our group between August 1995 and January 2001. In 29 patients (57%) an anterior hemifundoplication was added to the esophagomyotomy. In 22 patients (43%), no wrap was added. Patients scored (0 = none; 1 = mild; 2 = moderate; 3 = severe) symptom severity (dysphagia, regurgitation, heartburn, chest pain) preoperatively and postoperatively. Weight gain, use of gastrointestinal (GI) medication, tolerance to food, and patient satisfaction were also assessed.


RESULTS
Mean patient follow-up was 33 months, and there were no operative deaths. Four patients were converted to open operation (8%). The wrap and no wrap groups were similar in terms of esophageal dilation, preoperative symptom severity and duration (5.7 +/- 7.1 versus 6.1 +/- 7.0 years), and preoperative weight loss (18 +/- 15 versus 20 +/- 20 pounds). Both groups had similar improvement in symptom grade postoperatively and equivalent satisfaction rates (86%). Postoperative weight gain, GI medication use, and food intolerance was also similar. Postoperatively, patients in the wrap group did not have higher dysphagia scores or lower heartburn scores than the no wrap group.


CONCLUSIONS
The addition of anterior hemifundoplication to esophagomyotomy for achalasia does not improve or worsen clinical results.
Dempsey
Daniel T
DT
Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylavania, USA. dempsedt@tuhs.temple.edu
Delano
Matthew
M
Bradley
Kevin
K
Kolff
Jeffrey
J
Fisher
Carol
C
Caroline
Dina
D
Gaughan
John
J
Meilahn
John E
JE
Daly
John M
JM
D000328:Adult; D003131:Combined Modality Therapy; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017060:Patient Satisfaction; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome