Despite nearly absent esophageal contractility, Heller myotomy with Dorfundoplication and POEM result in similar long-term symptom relief, esophageal emptying, and occurrence of reintervention in patients with type I achalasia. There is decreased esophageal acid exposure with the addition of a fundoplication, without compromised esophageal drainage, allaying fears of a detrimental effect of a fundoplication. Minimally invasive ‘three stitch’ modification to the Dor fundoplication is simple and effective that simplifies classic Dor fundoplication with good palliation of symptoms and an acceptable rate of acid reflux.
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