A total fundoplication is not an obstacle to esophageal emptying after heller myotomy for achalasia: results of a long-term follow up.
OBJECTIVE
The aim of this study was to evaluate the role and efficacy of a total 360 degrees wrap, Nissen-Rossetti fundoplication, after esophagogastromyotomy in the treatment of esophageal achalasia.


BACKGROUND
Surgery actually achieves the best results in the treatment of esophageal achalasia; the options vary from a short extramucosal esophagomyotomy to an extended esophagogastromyotomy with an associated partial fundoplication to restore the main antireflux barrier. A total 360 degrees fundoplication is generally regarded as an obstacle to esophageal emptying.


METHODS
Since 1992 to November 2003, a total of 195 patients (91 males, 104 females), mean age 45.2 years (range, 12-79 years), underwent laparoscopic treatment of esophageal achalasia. Intervention consisted of Heller myotomy and Nissen-Rossetti fundoplication with intraoperative endoscopy and manometry.


RESULTS
In 3 patients (1.5%), a conversion to laparotomy was necessary. Mean operative time was 75 +/- 15 minutes. No mortality was observed. Overall major morbidity rate was 2.1%. Mean postoperative hospital stay was 3.6 +/- 1.1 days (range, 1-12 days). At a mean clinical follow up of 83.2 +/- 7 months (range, 3-141 months) on 182 patients (93.3%), an excellent or good outcome was observed in 167 patients (91.8%) (dysphagia DeMeester score 0-1). No improvement of dysphagia was observed in 4 patients (2.2%). Gastroesophageal pathologic reflux was absent in all the patients.


CONCLUSIONS
Laparoscopic Nissen-Rossetti fundoplication after Heller myotomy is a safe and effective treatment of esophageal achalasia with excellent results in terms of dysphagia resolution, providing total protection from the onset of gastroesophageal reflux.
Rossetti
Gianluca
G
I Division of General and Gastrointestinal Surgery, Second University of Naples, Naples, Italy. gianlucarossetti@yahoo.it
Brusciano
Luigi
L
Amato
Giuseppe
G
Maffettone
Vincenzo
V
Napolitano
Vincenzo
V
Russo
Gianluca
G
Izzo
Domenico
D
Russo
Federica
F
Pizza
Francesco
F
Del Genio
Gianmattia
G
Del Genio
Alberto
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome