Guest guest Posted July 23, 2011 Report Share Posted July 23, 2011 I don't have any study info but you might want to research the difference between the Dor Fundiplication and the Nissen Fundiplication. I believe the Dor is all the way wrapped around the esophagus and he Nissen is only 270 degrees around and the difference was an improvement to deal with the pressure. I believe the Nissen (270 degree one, not full 360 wrap) is now the preferred approach for most surgeons. Interested to hear what others say. On Jul 23, 2011, at 2:31 PM, pletchsr <pletchsr@...> wrote: > > > Hi all, > I am wondering. How long has Dor Fundoplication (the HM treatment of choice) been around? I find studies from 2005 etc where it was named the golden child because it prevented reflux, but I am curious, while I watch everyone jump on the dor fundo bandwagon, how long has it been used consistently? In other words I question getting this done because I am afraid that it will raise LES pressure in the long term, thinking 20+ years or so. I have to ask this forum cause if I said this to a doctor they'd get offended. I read one study, can't find it, and it did show a small increase in LES pressure in the dor vs. non-dor people, but it wasn't a significant increase, and the study only spanned about 2 or 3 years. My question is, after reading this study[1] and this study[2], how much does the dor fundo increase pressure, and what are the longitudinal studies on that? Thanks for any info anyone can give me. > S > > [1] http://www.ncbi.nlm.nih.gov/pubmed/10330937 > [2] http://www.ncbi.nlm.nih.gov/pubmed/21778895 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2011 Report Share Posted July 24, 2011 I had the Dor Fundoplication in 1990 and was told I was one of the first people to have it. I had to fight with the insurance company to pay for it as they thought it was " experimental " . The problem was it tightened over time and had to be taken down. At the recent Achalasia Symposium Dr. Schulz did say that each person is different and he uses Dor more often but he does use both. Blessings, JC ----------------------- Check out Cool People with Achalasia on Facebook http://www.facebook.com/groups/coolachalsia?ap=1 > > > > > > > Hi all, > > I am wondering. How long has Dor Fundoplication (the HM treatment of choice) been around? I find studies from 2005 etc where it was named the golden child because it prevented reflux, but I am curious, while I watch everyone jump on the dor fundo bandwagon, how long has it been used consistently? In other words I question getting this done because I am afraid that it will raise LES pressure in the long term, thinking 20+ years or so. I have to ask this forum cause if I said this to a doctor they'd get offended. I read one study, can't find it, and it did show a small increase in LES pressure in the dor vs. non-dor people, but it wasn't a significant increase, and the study only spanned about 2 or 3 years. My question is, after reading this study[1] and this study[2], how much does the dor fundo increase pressure, and what are the longitudinal studies on that? Thanks for any info anyone can give me. > > S > > > > [1] http://www.ncbi.nlm.nih.gov/pubmed/10330937 > > [2] http://www.ncbi.nlm.nih.gov/pubmed/21778895 > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2011 Report Share Posted July 24, 2011 wrote: > > ... I believe the Dor is all the way wrapped around the esophagus and > he Nissen is only 270 degrees around and the difference was an > improvement to deal with the pressure. ... > There are a number of fundoplications but for achalasia the Nissen, Dor and Toupet are the ones we most hear about with Dor being done most often. Toupet is the 270 degree one. Dor (Developed for achalasia and first described by Dor in 1962) is 180 degrees. Toupet and Dor are considered partial fundoplications. The Nissen is a full fundoplication, 360 degrees. The Nissen is used the most in acid reflux cases where there are no motility problems like achalasia. Some surgeons think even in acid reflux cases without achalasia the Nissen can be too much of a wrap and prefer the Toupet, at least in some cases such as children. Sometimes there is confusion about names because " Nissen " is sometime used as a synonym for fundoplication and Dor and toupet also get called Nissens or partial Nissens. Because achalasia makes it harder for getting food through the LES it is believed by most surgeons, but not all or not in all cases, that a full fundoplication creates too much resistance to food. Because of that concern most surgeons prefer to do either the Dor or Toupet for achalasia. As to fundoplications becoming too tight, it is an odd thing. If you look at studies about fundoplications without achalasia you don't see that problem. You do see them being made too tight or misformed, malpositioned, or too long. These can all act like it is " too tight. " In these cases the problem usually in known soon after the surgery. When it is simply made too tight in as little as a few months it may not be. So what is happening with achalasia? First, even though it is sometimes stated otherwise in this support group, in achalasia studies you don't see this being much of a problem. There are the ones that were made too tight but not many that " became " too tight. There are people in this support group that have had their fundoplications undone because they were " too tight. " So, it does happen but not that often. In fact, looking at studies about achalasia it looks like the bigger long-term problem with fundoplications is that they become looser and don't prevent as much reflux years latter. One thing that may be happening is that as achalasia progresses what would have been not too tight at one time is too tight latter even though it may actually be looser. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2011 Report Share Posted July 24, 2011 Thanks for all the details, Notan. You keep us all better informed. On Jul 24, 2011, at 11:35 AM, notan ostrich <notan_ostrich@...> wrote: > wrote: > > > > ... I believe the Dor is all the way wrapped around the esophagus and > > he Nissen is only 270 degrees around and the difference was an > > improvement to deal with the pressure. ... > > > > There are a number of fundoplications but for achalasia the Nissen, Dor > and Toupet are the ones we most hear about with Dor being done most > often. Toupet is the 270 degree one. Dor (Developed for achalasia and > first described by Dor in 1962) is 180 degrees. Toupet and Dor are > considered partial fundoplications. The Nissen is a full fundoplication, > 360 degrees. The Nissen is used the most in acid reflux cases where > there are no motility problems like achalasia. Some surgeons think even > in acid reflux cases without achalasia the Nissen can be too much of a > wrap and prefer the Toupet, at least in some cases such as children. > Sometimes there is confusion about names because " Nissen " is sometime > used as a synonym for fundoplication and Dor and toupet also get called > Nissens or partial Nissens. > > Because achalasia makes it harder for getting food through the LES it is > believed by most surgeons, but not all or not in all cases, that a full > fundoplication creates too much resistance to food. Because of that > concern most surgeons prefer to do either the Dor or Toupet for achalasia. > > As to fundoplications becoming too tight, it is an odd thing. If you > look at studies about fundoplications without achalasia you don't see > that problem. You do see them being made too tight or misformed, > malpositioned, or too long. These can all act like it is " too tight. " In > these cases the problem usually in known soon after the surgery. When it > is simply made too tight in as little as a few months it may not be. So > what is happening with achalasia? First, even though it is sometimes > stated otherwise in this support group, in achalasia studies you don't > see this being much of a problem. There are the ones that were made too > tight but not many that " became " too tight. There are people in this > support group that have had their fundoplications undone because they > were " too tight. " So, it does happen but not that often. In fact, > looking at studies about achalasia it looks like the bigger long-term > problem with fundoplications is that they become looser and don't > prevent as much reflux years latter. One thing that may be happening is > that as achalasia progresses what would have been not too tight at one > time is too tight latter even though it may actually be looser. > > notan > > Quote Link to comment Share on other sites More sharing options...
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