Heller Myotomy Versus Heller Myotomy With Dor Fundoplication for Achalasia: A Prospective Randomized Double-Blind Clinical Trial

摘要: Since the first report of laparoscopic Heller myotomy in 1991 by Shimi et al1 and thoracoscopic Pellegrini al2 1992, minimally invasive techniques have been increasingly used for treatment achalasia. Many surgeons noticed a distinct change referral patterns achalasia now that are available. Patti colleagues3 2002 reported during past decade, their center at University California, San Francisco, saw marked increase number patients who were referred with corresponding decrease use pneumatic balloon dilation or botulinum toxin injection. Laparoscopic is preferred Vanderbilt, we previously our results technique.4 A great deal controversy exists over appropriate antireflux procedures to prevent reflux after myotomy. The arguments using partial procedure summarized nicely Peters,5 against routine an presented group Society Surgery Alimentary Tract symposium 2000.6 A recent meta-analysis without from 2001 was performed Lyass al.7 Pathologic acid exposure identified 24-hour pH studies 7.9% 489 underwent fundoplication. Forty-seven had undergone studied monitoring only 4, 10%, 40 pathologic exposure. This concluded “based on data human subjects no recommendations could be made regarding efficacy protecting gastroesophageal (GER) esophageal myotomy.” We completed study randomized 43 alone plus Dor designed as double-blind, parallel-group trial test null hypothesis addition fundoplication will not alter incidence GER these patients.