Volume 26, Issue 1, April 2019, Pages 37–47
Anas AHALLAT1 and R. Kadiri2
1 Résident en Chirurgie Générale, clinique Chirurgicale C, Hôpital IBN SINA, Rabat, Morocco
2 Clinique chirurgicale C, Hôpital IBN SINA, Rabat, Morocco
Original language: French
Copyright © 2019 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Achalasia is a rare esophageal motility disorder, with unknown etiology. It is characterized by an esophageal aperistalsis, and a failure of relaxation of the lower esophageal sphincter in response to swallowing. The clinic, the barium swallow and endoscopy suggest the diagnosis; that is confirmed by manometry. Surgical treatment, palliative, provides excellent results in terms of dysphagia but increases gastroesophageal reflux risk. The combination of Heller myotomy and a fundoplication is used to prevent postoperative gastroesophageal reflux, but the results remain controversial. Our study aims to compare the postoperative results in terms of gastroesophageal reflux in both groups of patients who underwent the Heller myotomy with and without fundoplication, in order to challenge the interest of the systematic association of the fundoplication. Among the 34 patients in the study, 7 have benefited of the Heller myotomy with fundoplication, and 27 have benefited from the Heller myotomy without fundoplication. Our results showed that clinical gastroesophageal reflux occurred for 14% of patients with fundoplication and 18,5% of patients without fundoplication. On the other hand, the pH reflux occurred for 80% of patients with fundoplication and 69.2% of patients without fundoplication. The pH measurement analysis after the surgery showed an average GERD rate in a standing position of 1.9% in the group of patients with fundoplication and 7.2% in the group of patients without fundoplication. The same analysis showed an average rate of gastroesophageal reflux in a lying position of 30% for both groups. We concluded that there is no difference between using the fundoplication or not to prevent postoperative GERD, so it should be dedicated to specific cases such as hiatal hernia.
Author Keywords: Achalasia, dysphagia, gastroesophageal reflux, heller myotomy, Fundoplication.
Anas AHALLAT1 and R. Kadiri2
1 Résident en Chirurgie Générale, clinique Chirurgicale C, Hôpital IBN SINA, Rabat, Morocco
2 Clinique chirurgicale C, Hôpital IBN SINA, Rabat, Morocco
Original language: French
Copyright © 2019 ISSR Journals. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Achalasia is a rare esophageal motility disorder, with unknown etiology. It is characterized by an esophageal aperistalsis, and a failure of relaxation of the lower esophageal sphincter in response to swallowing. The clinic, the barium swallow and endoscopy suggest the diagnosis; that is confirmed by manometry. Surgical treatment, palliative, provides excellent results in terms of dysphagia but increases gastroesophageal reflux risk. The combination of Heller myotomy and a fundoplication is used to prevent postoperative gastroesophageal reflux, but the results remain controversial. Our study aims to compare the postoperative results in terms of gastroesophageal reflux in both groups of patients who underwent the Heller myotomy with and without fundoplication, in order to challenge the interest of the systematic association of the fundoplication. Among the 34 patients in the study, 7 have benefited of the Heller myotomy with fundoplication, and 27 have benefited from the Heller myotomy without fundoplication. Our results showed that clinical gastroesophageal reflux occurred for 14% of patients with fundoplication and 18,5% of patients without fundoplication. On the other hand, the pH reflux occurred for 80% of patients with fundoplication and 69.2% of patients without fundoplication. The pH measurement analysis after the surgery showed an average GERD rate in a standing position of 1.9% in the group of patients with fundoplication and 7.2% in the group of patients without fundoplication. The same analysis showed an average rate of gastroesophageal reflux in a lying position of 30% for both groups. We concluded that there is no difference between using the fundoplication or not to prevent postoperative GERD, so it should be dedicated to specific cases such as hiatal hernia.
Author Keywords: Achalasia, dysphagia, gastroesophageal reflux, heller myotomy, Fundoplication.
Abstract: (french)
L’achalasie est un trouble moteur primitif de l’œsophage d’étiologie inconnue, qui se caractérise par un apéristaltisme œsophagien, et un défaut de relaxation du sphincter inférieur de l’œsophage après la déglutition. Le diagnostic est évoqué par la clinique (dominée par la dysphagie), le TOGD et l’endoscopie, et confirmé par la manométrie. Le traitement chirurgical, bien que palliatif, offre d’excellents résultats en terme de dysphagie mais expose au risque de RGO. L’association d’un SAR à la myotomie de Heller est utilisée pour prévenir le RGO postopératoire, avec des résultats controversés. Notre étude a pour but de comparer les résultats postopératoires en terme de RGO chez deux groupes de patients ayant bénéficié de la myotomie de Heller avec et sans SAR, pour juger l’intérêt de l’association systématique du SAR. Nous avons inclus dans notre série 34 patients, opérés par voie cœlioscopique, parmi lesquels 7 ont bénéficié de la myotomie de Heller avec SAR et 27 sans SAR. Nos résultats ont montré la survenue de RGO clinique chez 14% des patients avec SAR et 18,5% des patients sans SAR. Le RGO pHmétrique est présent chez 80% des patients avec SAR et 69,2% des patients sans SAR. L’analyse du RGO pHmétrique a montré un taux moyen de RGO en position debout de 1,9% chez le groupe des patients avec SAR et 7,2% chez les patients sans SAR, le taux moyen de RGO en position couché est de 30% chez les 2 groupes. L’adjonction d’un SAR ne montre pas de différence dans la prévention du RGO postopératoire et doit être réservé à des situations particulières comme l’hernie hiatale.
Author Keywords: Dysphagie, Achalasie, Myotomie de Heller, RGO, système anti-reflux.
How to Cite this Article
Anas AHALLAT and R. Kadiri, “La place de la chirurgie du montage antireflux après myotomie de Heller laparoscopique pour achalasie de l’œsophage : A propos de 34 cas,” International Journal of Innovation and Applied Studies, vol. 26, no. 1, pp. 37–47, April 2019.
