421. MODIFIED DOR FUNDOPLICATION IN ACHALASIA PATIENTS: LONG-TERM OUTCOMES FROM A HIGH-VOLUME CENTRE

Abstract Background Heller myotomy combined with Dor fundoplication remains the gold standard in the treatment of achalasia. Dor fundoplication serves as a floppy partial fundoplication which, at the same time, prevents recurrence of dysphagia due to outflow obstruction to the myotomised esophagus. In this study, we propose a modified floppier anterior wrap and present our unit’s experience in a series of consecutive patients with achalasia. Methods The prospectively collected surgical achalasia database of our department was retrieved. All patients had manometric confirmation of the diagnosis and were operated by the same surgical team. Data regarding preoperative Eckardt, GERD and Quality of Life assessment scores were collected. Patients attended regular follow-up appointments. Those with abnormal Eckardt and GERD scores were subjected to objective testing using manometry and 24h impedance pHmetry. Results 118 patients with achalasia were subjected to Heller myotomy and modified Dor fundoplication from 01/2014 to 12/2020. 97 patients completed the follow-up appointments. Median follow-up was 72 months (28-120 months). 97% of patients reported a positive influence in their quality of life and did not regret undergoing surgery. 7/97 (7.2%) presented with an abnormal Eckardt score and 5/97 (5.2%) patients demonstrated an abnormal GERD score. Objective testing results with manometry and pH-studies of patients with abnormal scores will be completed within the next two months. Conclusion Our modified Dor fundoplication after Heller myotomy is a safe and efficient surgical method for treating achalasia. Long-term follow-up suggests significant and long-lasting improvement in Quality of Life and very low incidence of symptom relapse.