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Bianchi et al. Mini-invasive Surg 2017;1:153-9 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.41
www.misjournal.net
Topic: Achalasia Management: The South American Viewpoint Open Access

Heller-Pinotti, a modified partial

fundoplication associated with myotomy to

treat achalasia: technical and final results

from 445 patients

Edno Tales Bianchi, Rubens Antonio Aissar Sallum, Sergio Szachnowicz, Francisco Carlos Bernal Costa
Seguro, Andre Fonseca Duarte, Julio Rafael Mariano da Rocha, Ivan Cecconello
Departament of Gatrointestinal Surgery, Clinic Hospital, University of São Paulo, São Paulo 05403-010, Brazil.

Correspondence to: Dr. Edno Tales Bianchi, Departament of Gatrointestinal Surgery, Clinic Hospital, University of São Paulo, Rua Dr. Ovídio Pires de
Campos, 225, São Paulo 05403-010, Brazil. E-mail: ednotales@gmail.com
How to cite this article: Bianchi ET, Sallum RAA, Szachnowicz S, Seguro FCBC, Duarte AF, da Rocha JRM, Cecconello I. Heller-Pinotti, a modified
partial fundoplication associated with myotomy to treat achalasia: technical and final results from 445 patients. Mini-invasive Surg 2017;1:153-9.
ABSTRACT
Article history: Aim: The need for an antireflux procedure after myotomy is no longer as controversial as it used
Received: 27 Sep 2017 to be. However, the choice of the best fundoplication after myotomy is still controversial. The
First Decision: 6 Nov 2017 authors present the results of laparoscopic myotomies associated with postero-latero-anterior
Revised: 27 Nov 2017 fundoplications (Heller-Pinotti). Methods: Medical records and endoscopic findings were
Accepted: 30 Nov 2017 reviewed for achalasia patients that had submitted to the procedure following 5 years of follow-
Published: 28 Dec 2017 up. Results: In total, 445 patients were enrolled: 39 (8.7%) presented erosive esophagitis, the
Los Angeles classification being A-21, B-12, C-2 and D-4 (2 with peptic substenosis and 2
Key words: Barret); 41 (9.2%) patients had dysphagia, 4 needed reinterventions; 49 (11%) presented a
Achalasia, migration of the fundoplication wrap to the thorax due to hiatal hernia, this was correlated with
fundoplication, a higher risk of present erosive esophagitis (P = 0.047) and dysphagia (P < 0.001). Conclusion:
myotomy, Laparoscopy myotomy postero-latero-anterior fundoplication (Heller-Pinotti) produces a good
Heller-Pinotti long-term outcome for dealing with dysphagia and in terms of reflux prevention.

INTRODUCTION There is therefore a consensus that an antireflux
procedure should be performed at the time of the
myotomy.
Myotomy of the esophageal lower sphincter is the
best way to treat achalasia. It is expected that gastro The choice between a total fundoplication, anterior or
esophageal reflux occurs after this procedure because posterior, has already been the subject of studies and
one of the mechanisms of defense against reflux is meta-analysis in the literature, though the methods for
withdrawn. The incidence of postoperative reflux and improvement are still controversial.
related complications following open cardiomyotomy
without fundoplication varies between 20%-32% [1,2] . Some modifications were made over time in our unit.
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