Slovenská chirurgia 3/2015
Controversies of fundoplication after laparoscopic Heller´s myotomy. Metaanalysis
Objective: The authors make analysis of their choice of laparoscopic fundoplication applied after Heller´s myotomy (LHM) for achalasia. They compare Dor´s fundoplication with Toupet´s or other fundoplication, or myotomy without fundoplication. Discussion: The article presents the results of 6 research studies examining 523 patients after Heller´s laparoscopic myotomy and after Dor´s fundoplication, and compares those results with 8 other studies examining 528 patients after LHM with Toupet´s or other fundoplication, or without fundoplication. Evaluating criteria of the study taken into account are the occurrence of gastroesophageal reflux, regurgitation and perforation after surgery. Conclusion: Even when meta-analysis proves that the Dor´s fundoplication and LHM are not the best choice in comparison with other modifications, especially because of frequent presence of gastroesophageal reflux, authors assume that both methods will be used more often due to their simplicity, reliability and their technical effortlessness.
Keywords: achalasia, myotomy, fundoplication, complication