Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Abstract

Background Heller myotomy with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is still controversial. We compared both types of fundoplication concerning subjective and objective parameters. Methods A total of 30 consecutive patients underwent laparoscopic/robotic Heller myotomy (LHM/RHM) with either DF (n=15) or TF (n=15). Preoperative baseline characteristics, intraoperative details, and post-operative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, and 24-hour pH study and high-resolution manometry (HRM) at one year of follow-up. Results There was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and post-operative complications. The HM+DF group had 4 (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p= 0.79). Symptom scores were similar between the groups at 6 and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p=0.483). On HRM, HM+TF showed a trend towards significance in terms of esophagogastric junction (EGJ) relaxation (p=0.058) with a non-significant difference in median integrated relaxation pressure (IRP) (p=0.081). Conclusion The study showed a trend towards lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria.