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The Choice of Fundoplication After Myotomy for Achalasia—Reply
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In reply
We thank Dr Clemente for his kind comments regarding our recent achalasia outcomes article.1 He nicely summarizes 2 decades-old controversies regarding the surgical treatment of achalasia—how long does the myotomy need to be and which is the preferred antireflux procedure to use? He advocates a "minimalist" approach with little esophageal mobilization, a relatively short myotomy, and a Dor anterior fundoplication. We, on the other hand, describe a series of long myotomies (8 cm minimum) with a posterior partial wrap (a Toupet). Both reports describe excellent results with dysphagia relief; 96% in Dr Clemente's open series and 92% in ours. I would argue that this is the most important outcome end point for these patients who are almost always having surgery for esophageal obstructive symptoms. Who had the better antireflux repair, André Toupet or Jacques Dor? Both have their defenders with Dor proponents usually arguing for its mucosal covering . . . [Full Text of this Article]
AUTHOR INFORMATION
Lee Swanstrom, MD
RELATED LETTER
Laparoscopic Heller Myotomy With Toupet Fundoplication: Outcomes Predictors in 121 Consecutive Patients
Yashodhan S. Khajanchee, Shalini Kanneganti, Amy E. B. Leatherwood, Paul D. Hansen, and Lee L. Swanström
Arch Surg. 2005;140(9):827-834.
ABSTRACT
| FULL TEXT
RELATED ARTICLES
The Choice of Fundoplication After Myotomy for Achalasia
Gennaro Clemente
Arch Surg. 2006;141(6):612.
EXTRACT
| FULL TEXT
Laparoscopic Heller Myotomy With Toupet Fundoplication: Outcomes Predictors in 121 Consecutive Patients
Yashodhan S. Khajanchee, Shalini Kanneganti, Amy E. B. Leatherwood, Paul D. Hansen, and Lee L. Swanström
Arch Surg. 2005;140(9):827-834.
ABSTRACT
| FULL TEXT
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