title: Is Dor fundoplication optimum after laparoscopic Heller myotomy for achalasia? A meta-analysis.
abstract: OBJECTIVE
  To compare the outcome of acid reflux prevention by Dor fundoplication after laparoscopic Heller myotomy (LHM) for achalasia.
  
  
  METHODS
  Electronic database PubMed, Ovid (Evidence-Based Medicine Reviews, EmBase and Ovid MEDLINE) and Cochrane Library were searched between January 1995 and September 2012. Bibliographic citation management software (EndNote X3) was used for extracted literature management. Quality assessment of random controlled studies (RCTs) and non-RCTs was performed according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 and a modification of the Newcastle-Ottawa Scale, respectively. The data were analyzed using Review Manager (Version 5.1), and sensitivity analysis was performed by sequentially omitting each study.
  
  
  RESULTS
  Finally, 6 studies, including a total of 523 achalasia patients, compared Dor fundoplication with other types of fundoplication after LHM (Dor-other group), and 8 studies, including a total of 528 achalasia patients, compared Dor fundoplication with no fundoplication after LHM (Dor-no group). Dor fundoplication was associated with a significantly higher recurrence rate of clinical regurgitation and pathological acid reflux compared with the other fundoplication group (OR = 7.16, 95%CI: 1.25-40.93, P = 0.03, and OR = 3.79, 95%CI: 1.23-11.72, P = 0.02, respectively). In addition, there were no significant differences between Dor fundoplication and no fundoplication in all subjects. Other outcomes, including complications, dysphagia, postoperative physiologic testing, and operation-related data displayed no significant differences in the two comparison groups.
  
  
  CONCLUSIONS
  Dor fundoplication is not the optimum procedure after LHM for achalasia. We suggest more attention should be paid on quality of life among different fundoplications.
authors.affiliation: Ming-Tian Wei, Ya-Zhou He, Xiang-Bing Deng, Yuan-Chuan Zhang, Ting-Han Yang, Cheng-Wu Jin, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ming-Tian
authors.initials: MT
authors.lastname: Wei
authors.forename: Ya-Zhou
authors.initials: YZ
authors.lastname: He
authors.forename: Xiang-Bing
authors.initials: XB
authors.lastname: Deng
authors.forename: Yuan-Chuan
authors.initials: YC
authors.lastname: Zhang
authors.forename: Ting-Han
authors.initials: TH
authors.lastname: Yang
authors.forename: Cheng-Wu
authors.initials: CW
authors.lastname: Jin
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.forename: Zi-Qiang
authors.initials: ZQ
authors.lastname: Wang
mesh_terms: D016009:Chi-Square Distribution; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Achalasia; Dor fundoplication; Gastroesophageal reflux; Laparoscopic Heller myotomy; Meta-analysis