Dor Fundoplication Technique, Radiology, Diet | Dor fundoplication vs Nissen

What is Dor Fundoplication Surgery?

Achalasia is an esophageal motility problem in which the lower esophageal sphincter does not fully or even partially relax in response to swallowing. The current therapeutic intervention options are meant to alleviate symptoms, rather than cure the condition. It has been found that a laparoscopic Heller myotomy combined with a Dor fundoplication has a small prevalence of postoperative reflux and High rates of successful clinical outcomes. The effectiveness of the procedure depends on a well-executed procedure that follows major surgical stages.

Dor fundoplication is a two-row sutured anterior fundoplication used to avoid reflux following a Heller myotomy. Some surgeons believe that the combination of a Heller myotomy and a Dor fundoplication is more effective in preventing reflux than just a Heller myotomy alone. To remove the obstruction between the two, the muscular layer between the esophagus and stomach is divided during the process. The purpose of the surgery is to lower the pressure in the lower esophageal sphincter while simultaneously reducing the amount of gastroesophageal reflux.

Dor Fundoplication Technique

The Nissen fundoplication is a more common kind of surgical treatment for GERD. The Dor fundoplication procedure is a variant of the Nissen fundoplication. The Dor technique involves a partial wrap, preserving the stomach's capacity for expansion and contraction. When compared to the entire wrap that is performed during the Nissen procedure, this may result in fewer complications and side effects such as gas and bloating.

Laparoscopic techniques are commonly used to carry out the Dor procedure. This method entails creating a few tiny incisions in the patient's belly before inserting a laparoscope (a miniature camera) and other surgical equipment to carry out the surgery. In comparison to open surgery, laparoscopic surgery often has less discomfort, requires less hospitalization, and has a quicker recovery.

The Dor fundoplication technique involves possible dangers and side effects, just like any other surgical operation. These can include complications such as infection, hemorrhage, injury to the organs that are nearby, and trouble swallowing.

Dor Fundoplication Radiology

To evaluate the effectiveness of the Dor fundoplication procedure and identify any problems, radiographic assessment is an essential approach. For assessing postoperative fundoplication and related consequences, the primary imaging method is an upper GI contrast study. The extent of the gastric fundal defect surrounding the distal esophagus below the diaphragm should not exceed 2 cm. Gastric reflux should not occur, and there should be appropriate esophageal emptying.

Contrast radiography should be followed up in a planned way at predetermined intervals. It is essential to perform a videofluoroscopic contrast-enhanced esophagram shortly after surgery in order to provide anatomical analysis and identify any anatomical anomalies or difficulties, such as wrap issues, leaks, or persistent reflux. A CT scan should be utilized if there is any suspicion of a leak or bleeding after surgery, and postoperative fluoroscopic examination should be performed periodically.

Dor Fundoplication Diet

Dietary advice following Dor fundoplication surgery may vary based on the patient and the surgeon's preferences. However, it is usually recommended for patients to stick to a soft or liquid diet for the first few days following surgery before gradually adding solid foods as tolerated. Patients should stay away from calorie-dense, high-spice, and high-fat items such as french fries, burgers, and ice cream. Both alcoholic and carbonated drinks should be avoided. In order to avoid reflux, patients should consume small, frequent meals and refrain from lying down for at least two hours after eating. To promote optimal healing and avoid complications, it is vital to adhere to the surgeon's specific dietary recommendations.

Dor fundoplication vs Nissen

In a Dor fundoplication, the upper portion of the stomach is wrapped partially around the lower end of the esophagus, whereas a Nissen fundoplication includes a full wrap. Nissen may offer better reflux symptom control while Dor may cause less gas and bloating and reduce the risk of dysphagia. Each patient's symptoms and anatomy will determine which option is best.