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Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia
BACKGROUND: Laparoscopic Heller cardiomyotomy (LHC) is standard therapy for achalasia. Traditionally, an antireflux procedure has accompanied the myotomy. This study was undertaken to compare quality-of-life outcomes between patients undergoing myotomy with Toupet versus Dor fundoplication. In addit...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Society of Laparoendoscopic Surgeons
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154402/ https://www.ncbi.nlm.nih.gov/pubmed/25392612 http://dx.doi.org/10.4293/JSLS.2014.00191 |
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author | Tomasko, Jonathan M. Augustin, Toms Tran, Tung T. Haluck, Randy S. Rogers, Ann M. Lyn-Sue, Jerome R. |
author_facet | Tomasko, Jonathan M. Augustin, Toms Tran, Tung T. Haluck, Randy S. Rogers, Ann M. Lyn-Sue, Jerome R. |
author_sort | Tomasko, Jonathan M. |
collection | PubMed |
description | BACKGROUND: Laparoscopic Heller cardiomyotomy (LHC) is standard therapy for achalasia. Traditionally, an antireflux procedure has accompanied the myotomy. This study was undertaken to compare quality-of-life outcomes between patients undergoing myotomy with Toupet versus Dor fundoplication. In addition, we investigated overall patient satisfaction after LHC in the treatment of achalasia. METHODS: One hundred thirty-five patients who underwent LHC over a 13-year period were identified for inclusion. Symptoms queried included dysphagia, heartburn, and bloating using the Gastroesophageal Reflux Disease–Health-Related Quality of Life Scale and a second published scale for the assessment of gastroesophageal reflux disease and dysphagia symptoms. The patients' overall satisfaction after surgery was also rated. Data were compared on the basis of type of fundoplication. Symptom scores were analyzed using chi-square tests and Fisher's exact tests. RESULTS: Sixty-three patients completed the survey (47%). There were no perioperative deaths or reoperations. The mean length of stay was 2.8 days. The mean operative time for LHC with Toupet fundoplication was 137.3 ± 30.91 minutes and for LHC with Dor fundoplication was 111.5 ± 32.44 minutes (P = .006). There was no difference with respect to the incidence or severity of postoperative heartburn, dysphagia, or bloating. Overall satisfaction with Toupet fundoplication was 87.5% and with Dor fundoplication was 93.8% (P > .999). CONCLUSIONS: LHC with either Toupet or Dor fundoplication gave excellent patient satisfaction. Postoperative symptoms of heartburn and dysphagia were equivalent when comparing LHC with either antireflux procedure. Dor and Toupet fundoplication were found to have equivalent outcomes in the short term. We prefer Dor to Toupet fundoplication because of its decreased need for extensive dissection and better mucosal protection. |
format | Online Article Text |
id | pubmed-4154402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Society of Laparoendoscopic Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-41544022014-09-08 Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia Tomasko, Jonathan M. Augustin, Toms Tran, Tung T. Haluck, Randy S. Rogers, Ann M. Lyn-Sue, Jerome R. JSLS Scientific Papers BACKGROUND: Laparoscopic Heller cardiomyotomy (LHC) is standard therapy for achalasia. Traditionally, an antireflux procedure has accompanied the myotomy. This study was undertaken to compare quality-of-life outcomes between patients undergoing myotomy with Toupet versus Dor fundoplication. In addition, we investigated overall patient satisfaction after LHC in the treatment of achalasia. METHODS: One hundred thirty-five patients who underwent LHC over a 13-year period were identified for inclusion. Symptoms queried included dysphagia, heartburn, and bloating using the Gastroesophageal Reflux Disease–Health-Related Quality of Life Scale and a second published scale for the assessment of gastroesophageal reflux disease and dysphagia symptoms. The patients' overall satisfaction after surgery was also rated. Data were compared on the basis of type of fundoplication. Symptom scores were analyzed using chi-square tests and Fisher's exact tests. RESULTS: Sixty-three patients completed the survey (47%). There were no perioperative deaths or reoperations. The mean length of stay was 2.8 days. The mean operative time for LHC with Toupet fundoplication was 137.3 ± 30.91 minutes and for LHC with Dor fundoplication was 111.5 ± 32.44 minutes (P = .006). There was no difference with respect to the incidence or severity of postoperative heartburn, dysphagia, or bloating. Overall satisfaction with Toupet fundoplication was 87.5% and with Dor fundoplication was 93.8% (P > .999). CONCLUSIONS: LHC with either Toupet or Dor fundoplication gave excellent patient satisfaction. Postoperative symptoms of heartburn and dysphagia were equivalent when comparing LHC with either antireflux procedure. Dor and Toupet fundoplication were found to have equivalent outcomes in the short term. We prefer Dor to Toupet fundoplication because of its decreased need for extensive dissection and better mucosal protection. Society of Laparoendoscopic Surgeons 2014 /pmc/articles/PMC4154402/ /pubmed/25392612 http://dx.doi.org/10.4293/JSLS.2014.00191 Text en © 2014 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way. |
spellingShingle | Scientific Papers Tomasko, Jonathan M. Augustin, Toms Tran, Tung T. Haluck, Randy S. Rogers, Ann M. Lyn-Sue, Jerome R. Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia |
title | Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia |
title_full | Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia |
title_fullStr | Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia |
title_full_unstemmed | Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia |
title_short | Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia |
title_sort | quality of life comparing dor and toupet after heller myotomy for achalasia |
topic | Scientific Papers |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154402/ https://www.ncbi.nlm.nih.gov/pubmed/25392612 http://dx.doi.org/10.4293/JSLS.2014.00191 |
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