Laparoscopic Heller’s Cardiomyotomy (LHCM) is the surgical treatment of choice for achalasia. Addition of an antireflux procedure is recommended to reduce the postoperative reflux. However, there is no consensus regarding the ideal antireflux procedure. In an earlier study we have shown that Angle of His accentuation (AOH) is similar to Dor fundoplication. In this study we present the interim results of an RCT comparing AOH with Toupet fundoplication as an adjunct to LHCM. Methods Patients of Achalasia cardia presenting after October 2017 were randomised to receive either AOH or Toupet following Heller cardiomyotomy based on computer generated random sequence. Primary outcome was incidence of post-operative symptomatic reflux and esophagitis on endoscopy. Secondary outcome was relief of dysphagia and Achalasia specific health related Quality of life assessment (ASHRQoL). Symptom scores for dysphagia, regurgitation and heartburn as well as ASHRQoL were noted pre operatively and at 3 monthly intervals. Objective evaluation was done using timed barium swallow, Upper GI endoscopy and oesophageal manometry. Data was recorded on excel spreadsheet and analysis done using SPSS v5. Results A total of 52 patients (25 Toupet, 27 AOH) were included in the analysis. All patients were successfully operated laparoscopically with no conversions, intraoperative perforations or perioperative mortality. The mean operative duration was 128 min in the AOH group and 146 min in the Toupet group (p < 0.05). There was significant improvement in symptom scores as well as objective parameters in both groups with no difference between the 2 groups at a mean follow-up of 6 months (5-9 months; Table 1). 3 patients in AOH group (11%) and 4(16%) patients had new onset reflux with esophagitis in 2 patients in each group. Conclusion AOH is technically easier and can be performed in a shorter time. The symptom relief is similar in both groups with similar incidence of heartburn and esophagitis in the short term. A longer follow up is recommended in a larger number of patients.

中文翻译：

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178 随机对照试验，在接受腹腔镜 HELLERS 肌切开术的患者中比较他的重音角与 TOUPET FUNDOPLICATION：中期结果

腹腔镜海勒心肌切开术 (LHCM) 是贲门失弛缓症的首选手术治疗方法。建议增加抗反流程序以减少术后反流。然而，关于理想的抗反流程序尚无共识。在早期的研究中，我们已经表明他的重音角 (AOH) 类似于 Dor 胃底折叠术。在这项研究中，我们展示了一项 RCT 的中期结果，该结果将 AOH 与 Toupet 胃底折叠术作为 LHCM 的辅助手段进行了比较。方法 2017 年 10 月后出现贲门失弛缓症的患者在 Heller 心肌切开术后根据计算机生成的随机序列随机接受 AOH 或 Toupet。主要结果是内镜检查发现术后症状性反流和食管炎的发生率。次要结果是吞咽困难和贲门失弛缓症特定健康相关生活质量评估 (ASHRQoL) 的缓解。术前和每隔 3 个月记录吞咽困难、反流和胃灼热的症状评分以及 ASHRQoL。使用定时钡餐、上消化道内窥镜检查和食管测压法进行客观评估。数据记录在 Excel 电子表格中，并使用 SPSS v5 进行分析。结果共有52名患者（25 Toupet，27 AOH）被纳入分析。所有患者均成功完成腹腔镜手术，无中转、术中穿孔及围手术期死亡。AOH 组的平均手术时间为 128 分钟，Toupet 组为 146 分钟（p < 0.05）。两组的症状评分和客观参数均有显着改善，平均随访 6 个月（5-9 个月；表 1），两组之间没有差异。AOH组3例（11%）和4例（16%）每组2例新发反流伴食管炎。结论 AOH 在技术上更简单，可以在更短的时间内完成。两组的症状缓解相似，短期内烧心和食管炎的发生率相似。建议对大量患者进行更长时间的随访。两组的症状缓解相似，短期内烧心和食管炎的发生率相似。建议对大量患者进行更长时间的随访。两组的症状缓解相似，短期内烧心和食管炎的发生率相似。建议对大量患者进行更长时间的随访。