In this study, researchers evaluated the addition of Dor fundoplication on the incidence of postoperative gastroesophageal reflux after Heller myotomy.
They performed a prospective, randomized, double-blind, institutional review board-approved clinical trial.
A total of 43 patients with achalasia were randomized to either Heller myotomy or Heller myotomy plus Dor fundoplication.
There were no differences in the baseline characteristics of the 2 groups of patients.
The patients were studied via 24-hour pH study and manometry at 6 months postoperatively.
|Gastroesophageal reflux occurred in 48% of patients in the Heller only group.|
|Annals of Surgery|
The researchers defined pathologic gastroesophageal reflux as distal esophageal time acid exposure time greater than 4.2% per 24-hour period.
The team found that pathologic gastroesophageal reflux occurred in 48% of patients in the Heller only group and in 9% of patients in the Heller plus Dor group.
They determined that Heller plus Dor was associated with a significant reduction in the risk of gastroesophageal reflux (relative risk 0.11).
There was no significant difference in surgical outcome between the 2 techniques with respect to postoperative lower-esophageal sphincter pressure or postoperative dysphagia score.
Dr William Richards and colleagues concluded, "Heller myotomy plus Dor fundoplication was superior to Heller myotomy alone in regard to the incidence of postoperative gastroesophageal reflux".