Wrapped in controversy: trends in fundoplication at myotomy for achalasia in Christchurch, New Zealand.

AIM

A surgical approach to the management of achalasia involves myotomy, typically with added anti-reflux procedure. The most appropriate fundoplication in this setting (total Nissen, partial anterior Dor, or partial posterior Toupet) remains controversial. We present the trends in fundoplication procedures performed at myotomy in Christchurch between 1997 and 2009, and compare this with the literature.

METHODS

34 cases of achalasia managed with myotomy and various types of fundoplication in Christchurch between 1997 and 2009 were separated into two temporal groups, and the type of surgery in each group analysed. Data was obtained from the clinical records on specific short and long-term postoperative complications.

RESULTS

There is a decrease over time in myotomy without fundoplication and in total Nissen fundoplications performed. The number of posterior fundoplications remains equal over both time periods; however the proportion of anterior fundoplications is significantly increased in the later group. Three cases of mucosal perforation occurred during myotomy associated with anterior fundoplication, and reintervention rates were highest in myotomy only and anterior fundoplication patients.

CONCLUSION

Trends in anti-reflux surgery in Christchurch reflect the development of the evidence base in the literature. The change in fundoplication procedure is not clearly explained by the complication rates.