Does laparoscopic cardiomyotomy require an antireflux procedure?
Abstract
There is controversy concerning the need for an antireflux procedure in patients undergoing open or endoscopic cardiomyotomy for achalasia. The addition of an antireflux wrap (partial or total), while preventing reflux, may result in persistence or incomplete relief of dysphagia in patients with total oesophageal aperistalsis. The technique of laparoscopic cardiomyotomy used in Dundee preserves the lateral and posterior attachments of the gastro-oesophageal junction, and was designed to minimize the risk of gastro-oesophageal reflux. A consecutive series of patients with achalasia (n = 19) were treated by laparoscopic cardiomyotomy using the Dundee technique, which limits the mobilization to the anterior wall of the abdominal and thoracic oesophagus. The patients were followed up prospectively to assess the long-term relief of dysphagia and the postoperative incidence of reflux symptoms, with or without oesophagitis. The follow-up symptoms and assessment of the patients (15-53 months, median 27 months) showed total relief (n = 12) or substantial relief (n = 5) of dysphagia in 89%. On assessment at a median follow-up of 27 months, the number of patients experiencing heartburn after this operation increased from four of 15 to fiv...Continue Reading
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