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Winston et al: Management and outcomes of 13 dogs treated with a modified Heller myotomy and Dor fundoplication for lower esophageal sphincter achalasia-like syndrome
Veterinary Surgery 2, 2023

🔍 Key Findings

  • Modified Heller myotomy with Dor fundoplication improved vomiting/regurgitation scores by 180%, QoL by 100%, and owner-perceived body weight by 63% (P < .05).
  • 6 of 9 dogs with postoperative VFSS showed objective improvement in gastric filling scores; others remained stable.
  • Oral sildenafil was discontinued postoperatively in all dogs, indicating surgical success comparable to medical management.
  • 12 of 13 dogs survived to discharge; one dog was euthanized due to aspiration pneumonia postoperatively.
  • 50% of dogs experienced gastrostomy tube complications, higher than reported in previous literature.
  • Most complications were gastrostomy-tube related, with some requiring surgical correction (e.g., tube migration, leakage).
  • Feeding strategies (Bailey chair, elevated bowls) and food consistency (gruel/liquid) remained essential postoperatively to control regurgitation.
  • 9 of 11 owners would opt for the surgery again; those who wouldn’t cited risk or lack of efficacy.

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← Articles

Winston et al: Management and outcomes of 13 dogs treated with a modified Heller myotomy and Dor fundoplication for lower esophageal sphincter achalasia-like syndrome
Veterinary Surgery 2, 2023

🔍 Key Findings

  • Modified Heller myotomy with Dor fundoplication improved vomiting/regurgitation scores by 180%, QoL by 100%, and owner-perceived body weight by 63% (P < .05).
  • 6 of 9 dogs with postoperative VFSS showed objective improvement in gastric filling scores; others remained stable.
  • Oral sildenafil was discontinued postoperatively in all dogs, indicating surgical success comparable to medical management.
  • 12 of 13 dogs survived to discharge; one dog was euthanized due to aspiration pneumonia postoperatively.
  • 50% of dogs experienced gastrostomy tube complications, higher than reported in previous literature.
  • Most complications were gastrostomy-tube related, with some requiring surgical correction (e.g., tube migration, leakage).
  • Feeding strategies (Bailey chair, elevated bowls) and food consistency (gruel/liquid) remained essential postoperatively to control regurgitation.
  • 9 of 11 owners would opt for the surgery again; those who wouldn’t cited risk or lack of efficacy.

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Multiple Choice Questions on this study

In Winston 2023 et al., on LES-AS surgery outcomes, what was the most commonly reported long-term feeding modification?

A. Upright feeding with floor-level bowls
B. Feeding raw diet only
C. Feeding dry kibble in small portions
D. Bailey chair feeding with soft gruel
E. PEG tube long-term use only

Answer: Bailey chair feeding with soft gruel

Explanation: Most owners reported feeding soft gruel and using Bailey chairs postoperatively to reduce regurgitation.
In Winston 2023 et al., on LES-AS surgery outcomes, what percentage of dogs showed objective improvement in VFSS gastric filling scores after surgery?

A. 33%
B. 50%
C. 66%
D. 75%
E. 90%

Answer: 66%

Explanation: 6 of 9 dogs that underwent postoperative VFSS showed improved gastric filling scores.
In Winston 2023 et al., on LES-AS surgery outcomes, which preoperative treatment was discontinued postoperatively in all dogs?

A. Metoclopramide
B. Botulinum toxin A
C. Sildenafil
D. Cisapride
E. Pantoprazole

Answer: Sildenafil

Explanation: Oral sildenafil was stopped after surgery, supporting the idea that surgical treatment alone was effective in maintaining clinical improvement.
In Winston 2023 et al., on LES-AS surgery outcomes, what percentage of dogs experienced complications related to gastrostomy tubes?

A. 25%
B. 33%
C. 42%
D. 50%
E. 75%

Answer: 50%

Explanation: Half of the dogs that survived to discharge experienced gastrostomy tube complications, highlighting the importance of postoperative management.
In Winston 2023 et al., on LES-AS surgery outcomes, which of the following best describes the surgical approach used for the myotomy?

A. Single dorsal thoracotomy with esophagectomy
B. Transhiatal esophagectomy with stapled closure
C. Laparoscopic myotomy with Nissen fundoplication
D. Ventral midline celiotomy with Dor fundoplication
E. Thoracoscopic myotomy with Toupet fundoplication

Answer: Ventral midline celiotomy with Dor fundoplication

Explanation: The authors performed a standard ventral midline celiotomy with a modified Heller myotomy and Dor fundoplication.

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