{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:31:34Z","timestamp":1786739494382,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Laparoscopic Heller\u2019s myotomy (LHM) with a partial fundoplication is the standard surgical therapy for achalasia cardia. However, the ideal gastric extension of the myotomy remains controversial, as it may influence both symptom relief and post-operative gastro-oesophageal reflux disease (GORD). This study prospectively assessed the impact of gastric myotomy length on clinical outcomes after LHM with Dor fundoplication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>In this prospective non-randomised comparative interventional study, patients undergoing LHM with Dor fundoplication were divided into three groups according to gastric myotomy length: Group A (&lt;1.5 cm), Group B (1.5\u20132.5 cm) and Group C (&gt;2.5 cm). The primary outcome was improvement in the Eckardt score at 1, 3 and 6 months postoperatively. The secondary outcomes included GORD incidence (Gastro-Oesophageal Reflux Disease Questionnaire [GORD-Q]), complications and re-intervention rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Sixty-three patients were included (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 21 per group). All groups showed significant symptom improvement post-surgery. At 3 and 6 months, Groups B and C demonstrated greater Eckardt score improvement than Group A (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.012 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01, respectively). Median GORD-Q scores were similar at 1 and 3 months but higher in Group C at 6 months (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01). Re-intervention was most frequent in Group A (23.8%) due to persistent dysphagia (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.047). Operative time, hospital stay and complications did not differ significantly among the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Gastric myotomy beyond 1.5 cm improves symptom control after LHM with Dor fundoplication, but extension beyond 2.5 cm increases reflux risk. A length of 1.5\u20132.5 cm appears optimal for balancing dysphagia relief and reflux prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmas.jmas_534_25","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T17:01:45Z","timestamp":1779469305000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Balancing relief and reflux: A prospective comparative study on gastric myotomy length and post-operative outcomes in laparoscopic Heller\u2019s myotomy for achalasia"],"prefix":"10.4103","author":[{"given":"Sitaram","family":"Yadav","sequence":"first","affiliation":[{"name":"Department of Surgical Gastroenterology, National Institute of Medical Sciences and Research, NIMS University Rajasthan, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SP","family":"Kiran","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, National Institute of Medical Sciences and Research, NIMS University Rajasthan, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay Kumar","family":"Gurjar","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, National Institute of Medical Sciences and Research, NIMS University Rajasthan, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddharth D. 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