title: [Laparoscopic total fundoplication is not an obstacle to oesophageal emptying after oesophago-gastric myotomy for the surgical treatment of achalasia].
abstract: There are different surgical possibilities for the treatment of oesophageal achalasia ranging from a short extramucosal oesophagomyotomy to an extended esophago-gastric myotomy combined with a partial fundoplication to restore the main antireflux barrier. A total 360 degrees fundoplication is generally regarded as an obstacle to oesophageal emptying. The aim of this study was to evaluate the role and efficacy of total 360 degrees laparoscopic Nissen-Rossetti fundoplication after oesophago gastric myotomy in the treatment of oesophageal achalasia. From 1992 to January 2008, a total of 245 patients (112 males, 133 females), mean age 45.1 years (range: 12-79), were submitted to laparoscopic Nissen-Rossetti fundoplication after a Heller myotomy with endoscopic and manometric intraoperative monitoring. In 3 patients (1.2%), conversion to laparotomy was necessary. Mean operative time was 60 +/- 15 minutes. No mortality was observed. The overall morbidity rate was 1.6%. The mean postoperative hospital stay was 3.5 +/- 1.0 days (range: 1-12 days). A mean clinical follow-up of 100.2 +/- 7 months (range: 3-177) was possible for 228 patients (93.1%), and an excellent or good outcome was observed in 209 patients (91.7%) (DeMeester dysphagia score 0-1). No improvement in dysphagia was observed in 5 (2.2%) patients. Pathological gastro-oesophageal reflux was absent in all patients. Laparoscopic Nissen-Rossetti fundoplication after a Heller myotomy is a safe, effective treatment for oesophageal achalasia with excellent results in terms of dysphagia resolution, affording total protection from the onset of gastrooesophageal reflux.
authors.affiliation: I Divisione di Chirurgia Generale e Gastrointestinale, Seconda Università di Napoli, Napoli.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pizza
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.forename: Gianmattia
authors.initials: G
authors.lastname: Del Genio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Maffettone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Napolitano
authors.forename: Alfredo
authors.initials: A
authors.lastname: Allaria
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.forename: Luca
authors.initials: L
authors.lastname: Montesarchio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.forename: Maria
authors.initials: M
authors.lastname: Di Martino
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Lucido
authors.forename: Luigi
authors.initials: L
authors.lastname: Barra
authors.forename: Saverio
authors.initials: S
authors.lastname: Giugliano
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Alessandro
authors.forename: Federica
authors.initials: F
authors.lastname: Del Genio
authors.forename: Nunzia Luisa
authors.initials: NL
authors.lastname: Pizza
authors.forename: Alberto
authors.initials: A
authors.lastname: Del Genio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003680:Deglutition Disorders / Q000209:etiology; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000517:prevention & control*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome