Heller myotomy versus Heller myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis

• Published in: Annals of the Royal College of Surgeons of England Vol. 104; no. 3; pp. 158 - 164
• Main Authors: Santoro, G, Sheriff, N, Noronha, J, Nunes, Q M, Tandon, A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2022; Royal College of Surgeons
• Subjects: Age; Aged; Bias; Deglutition Disorders - epidemiology; Dysphagia; Endoscopy; Esophageal Achalasia - epidemiology; Esophageal Achalasia - surgery; Female; Fundoplication - adverse effects; Fundoplication - statistics & numerical data; Gastroesophageal reflux; Handbooks; Heart attacks; Heller Myotomy - adverse effects; Heller Myotomy - statistics & numerical data; Humans; Laparoscopy; Male; Meta-analysis; Middle Aged; Patients; Pneumonia; Population; Postoperative Complications - epidemiology; Review; Systematic review; Treatment Outcome; Heller myotomy; Fundoplication; Achalasia; Meta-analysis
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2020.7123

Heller myotomy (HM) remains the gold standard procedure for achalasia. The addition of different types of fundoplication to HM has been debated in several studies. Given the contradictory reports, this meta-analysis was undertaken to compare different outcomes after HM and HM with fundoplication (HMF). An electronic search was performed among five major databases (PubMed, Ovid, Scopus, Cochrane Library, Google Scholar) from inception to October 2019, identifying all randomised and non-randomised studies comparing HM with HMF. Two authors searched electronic databases using the keywords 'achalasia' AND 'dysphagia' AND 'gastroesophageal reflux' and all data were pooled for random-effects meta-analysis. The primary and secondary outcomes were gastroesophageal reflux and dysphagia, respectively. A total of six studies were included and involved 576 patients comparing HM and HMF. There was no statistically significant difference between gastroesophageal reflux in the HM vs HMF group (21.3% vs 22.9%, RR 1.32, 95% CI 0.60-2.88, = 0.49). There was a slightly higher incidence of dysphagia observed in HM vs HMF (14.8% vs 10.8%, RR 1.54, 95% CI 0.98-2.41, = 0.06). There was no statistically significant difference in long-term outcomes between a group of patients undergoing HM and a group who underwent HM with fundoplication.