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I read with interest the article by Khajanchee et al¹ published in the ARCHIVES. In my opinion, this study was perfectly conducted and followed rigorous criteria. For this reason, I express my appreciation to the authors. They studied the effectiveness of posterior Toupet fundoplication for the prevention of gastroesophageal reflux (GER) after Heller myotomy for achalasia. The results, as far as the improvement of dysphagia is concerned, are good with a greater than 90% improvement. Unfortunately, GER was found in 33% of patients in the postoperative pH studies after a median 9-month follow-up. The authors bring forth 2 hypotheses to explain this finding: their "aggressive myotomy" technique and their "aggressive use of postoperative pH" studies. In my opinion, the explanation for these results could be Toupet fundoplication. This technique is effective in the treatment of primary GER, but it is well known that the majority of surgeons prefer . . . [Full Text of this Article]

AUTHOR INFORMATION
Gennaro Clemente, MD

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