title: Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia.
abstract: OBJECTIVE
  To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.
  
  
  METHODS
  Fifty-six patients (26 men, 30 women; mean age 42.8 ± 14.7 years) presenting for minimally invasive surgery for oesophageal achalasia, were enrolled. All patients underwent laparoscopic Heller myotomy followed by a 180° anterior partial fundoplication in 30 cases (group 1) and calibrated Nissen-Rossetti fundoplication in 26 (group 2). Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication. A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken. One and two years after surgery, the patients underwent symptom questionnaires, endoscopy, oesophageal manometry and 24 h oesophago-gastric pH monitoring.
  
  
  RESULTS
  At the 2-year follow-up, no significant difference in the median symptom score was observed between the 2 groups (P = 0.66; Mann-Whitney U-test). The median percentage time with oesophageal pH < 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group (2; range 0.8-10 vs 0.35; range 0-2) (P < 0.0001; Mann-Whitney U-test).
  
  
  CONCLUSIONS
  Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia. Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure.
authors.affiliation: VIII Department of General and Gastrointestinal Surgery, School of Medicine, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy.
authors.forename: Natale
authors.initials: N
authors.lastname: Di Martino
authors.forename: Antonio
authors.initials: A
authors.lastname: Brillantino
authors.forename: Luigi
authors.initials: L
authors.lastname: Monaco
authors.forename: Luigi
authors.initials: L
authors.lastname: Marano
authors.forename: Michele
authors.initials: M
authors.lastname: Schettino
authors.forename: Raffaele
authors.initials: R
authors.lastname: Porfidia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Izzo
authors.forename: Angelo
authors.initials: A
authors.lastname: Cosenza
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome