OA07.5. Systematic Review and Network Meta-Analysis Comparing Fundoplication Techniques Following Heller Myotomy: A Collaborative Multi-Society Project

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ID: 326185
2026
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Abstract
Abstract Topic Benign Disease: Esophageal Function and Motility Background Several fundoplication techniques have been used to mitigate postoperative reflux among patients undergoing Heller myotomy, but the optimal technique is unclear. We performed a systematic review to compare the safety and efficacy of fundoplication techniques following Heller myotomy for patients with achalasia. Methods We searched PubMed, Embase, and Cochrane Central on July 9th, 2025, to identify eligible randomized trials. An international, multidisciplinary panel representing the AATS, CATS, EAES, and SAGES consisting of four general surgeons, two thoracic surgeons, two gastroenterologists, and two patient partners prioritized patient-important outcomes and set minimally important difference (MID) thresholds across outcomes. We performed a network meta-analysis to synthesize direct and indirect evidence among patients who underwent Heller myotomy with Nissen, Dor, and Toupet fundoplication. We appraised the certainty of evidence using core GRADE. Results We identified five randomized trials comparing patients treated with Heller myotomy with Dor (n=185), Toupet (n=81), and Nissen (n=92) fundoplication. Heller myotomy with Dor fundoplication may reduce dysphagia at 2 years [ARD 54 fewer per 1,000, 95% CI 180 fewer to 134 more; moderate effect] compared to Heller myotomy with Toupet fundoplication (Table 1). Heller myotomy with Dor fundoplication may reduce dysphagia [ARD 64 fewer per 1,000, 95% CI 97 fewer to 40 more; moderate effect] and increase reflux [ARD 68 more per 1,000, 95% CI 15 more to 116 more; small effect] compared to Heller myotomy with Nissen fundoplication. Conclusion Heller myotomy with Dor fundoplication may reduce dysphagia at 2 years compared to Heller myotomy with Toupet or Nissen fundoplication but may increase reflux at 2 years compared to Heller myotomy with Nissen fundoplication.
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Authors Bright Huo, Miloš Bjelović, Sonia Fernandez-Ananin, Ivy Haskins, Geoffrey P. Kohn, Siva Raja, Biniam Kidane, Zuzana Vacková, Irene Marafini, Suzanne Doré, Ian Tuddenham, Aaron Yu, Roi Anteby, Daniel Moritz Felsenreich, Sofia Tsokani, Dimitris Mavridis, Stephanie Sanger, Bethany J. Slater, Xiaomei Yao, Stavros A. Antoniou, Gordon H. Guyatt
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.052
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.052/70760210/doag077.052.pdf
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