title: Comparison of the Heller-Toupet procedure with the Heller-Dor procedure in patients who underwent laparoscopic surgery for achalasia.
abstract: OBJECTIVE
  We compared the outcomes of Toupet fundoplication with those of Dor fundoplication in patients with achalasia who underwent laparoscopic Heller myotomy.
  
  
  METHODS
  Seventy-two patients with achalasia and dysphagia underwent laparoscopic Heller myotomy with fundoplication performed by a single surgeon. Heller-Toupet fundoplication (HT) was performed in 30 patients, and Heller-Dor fundoplication (HD) was done in 42. The symptoms and esophageal function were retrospectively assessed in both groups.
  
  
  RESULTS
  The dysphagia scores significantly decreased after both the HT and HD procedures, and did not differ significantly between them. The incidence of reflux symptoms was significantly higher after HT (26.7%) than after HD (7.1%). The lower esophageal sphincter (LES) resting pressure significantly decreased after both HT and HD. Upon endoscopic examination, the incidence of reflux esophagitis was significantly higher after HT (38.5%) than after HD (8.8%). During esophageal pH monitoring, the fraction time at pH <4 was similar in the patients who underwent HT and HD.
  
  
  CONCLUSIONS
  Laparoscopic Heller myotomy provided significant improvements in the dysphagia symptoms of achalasia patients, regardless of the type of fundoplication. The incidences of reflux symptoms and reflux esophagitis were higher after HT than after HD. However, the results of pH monitoring did not differ between the procedures.
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, 2-1-1, Asamizodai, Minami-ku, Sagamihara, Kanagawa, 252-0380, Japan, katada@kitasato-u.ac.jp.
authors.forename: Natsuya
authors.initials: N
authors.lastname: Katada
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sakuramoto
authors.forename: Keishi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Kei
authors.initials: K
authors.lastname: Hosoda
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Shibata
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Moriya
authors.forename: Shiro
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003680:Deglutition Disorders / Q000601:surgery; D004931:Esophageal Achalasia / Q000601:surgery*; D004939:Esophageal Perforation / Q000453:epidemiology; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000379:methods* / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult