Effectiveness of laparoscopic esophagocardiomyotomy combined with various modifications of fundoplication in the treatment of achalasia cardia

Abstract

To analyze the results of laparoscopic esophagocardiomyotomy with original fundoplication and Dor fundoplication. Laparoscopic esophagocardiomyotomy with fundoplication was performed in 196 patients with achalasia cardia. Patients with achalasia stage 2 comprised 48.5% (95/196), stage 3 - 51.5% (101/196). Two groups were distinguished depending on surgery: Dor fundoplication (group 1, n=53) and Allakhverdyan fundoplication (group 2, n=143). Statistical analysis of data was carried out. Surgery time in the first group was longer by 35 minutes (p=0.000), blood loss - by 30 ml (p=0.000), postoperative hospital-stay - by 3 days. Pulmonary complications occurred in 34% and 2% of patients, respectively (p=0.002). In the first group, reflux esophagitis in 3 months after surgery was found in 62% of patients, after 6 months - 72%, after a year - in 74% of patients. In the second group, these values were 24%, 8% and 3%, respectively. Dysphagia developed in 2% and 1% of cases, respectively (p=0.767). Dor fundoplication demonstrates unsatisfactory long-term results and should be currently considered as historical stage in surgical treatment of achalasia cardia.