Anterior Dor or posterior Toupet with Heller Myotomy for Achalasia Cardia: a systematic review and meta-analysis

Siddaiah-Subramanya, Manjunath and Yunus, Rossita Mohamad and Khan, Shahjahan and Memon, Breda and Memon, Muhammed Ashraf (2019) Anterior Dor or posterior Toupet with Heller Myotomy for Achalasia Cardia: a systematic review and meta-analysis. World Journal of Surgery . ISSN 0364-2313


Background and Aims:
Partial fundoplication is commonly performed in conjunction with Heller Myotomy (HL). It is however controversial whether anterior Dor or posterior Toupet partial fundoplication is the anti-reflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures.

Material and Methods:
A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, Google scholar and current contents for English language articles comparing Dor and Toupet fundoplication following HM between 1991 and 2018 was performed. The outcome variables analyzed included operating time, length of hospital stay (LOHS), overall complication rate, quality of life (QOL), postoperative reflux, residual postoperative dysphagia, treatment failure and reoperations. The meta-analysis was prepared in accordance with the PRISMA-P statement.

Seven studies totaling 486 patients (Dor = 245, Toupet = 241) were analyzed. LOHS was significantly shorter for Toupet repair compared to Dor procedure (WMD 0.73, 95% CI: 0.47 to 0.99; P <0.0001). Furthermore, patients after Toupet experienced significantly better QOL than those after Dor (WMD 1.68, 95% CI: 0.68 to 2.73, P < 0.001). All other variables showed comparable effects for these two procedures.

Our systematic review and meta-analysis revealed that Toupet fundoplication is superior to Dor in terms of LOHS and QOL following HM. For other variables such as postoperative reflux, postoperative dysphagia, complication rates and treatment failure, both Dor and Toupet fundoplication produced effective and equivalent results.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Published online: 12 February 2019. Accepted version embargoed until 1 May 2020 (12 months), in accordance with the copyright policy of the publisher.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Agricultural, Computational and Environmental Sciences
Date Deposited: 01 May 2019 01:44
Last Modified: 13 Jun 2019 05:53
Uncontrolled Keywords: Achalasia; Heller Cardiomyotomy; partial fundoplication; Dor fundoplication; Toupet fundoplication; laparoscopic method; comparative trials; randomized controlled trials; human
Fields of Research : 11 Medical and Health Sciences > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified
01 Mathematical Sciences > 0104 Statistics > 010402 Biostatistics
Socio-Economic Objective: E Expanding Knowledge > 97 Expanding Knowledge > 970111 Expanding Knowledge in the Medical and Health Sciences
E Expanding Knowledge > 97 Expanding Knowledge > 970101 Expanding Knowledge in the Mathematical Sciences
Identification Number or DOI: 10.1007/s00268-019-04945-9

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