الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Gastroesophageal reflux disease (GERD) is a common global disorder. Manifestations of the disease range from occasional episodes of heartburn and regurgitation to the more serious
complications of stricture and Barrett’s esophagus. Most patients
manage their symptoms with a combination of dietary and lifestyle
modifications and over-the-counter or prescription medications.
However, reflux disease impacts their quality of life (QOL). It has
been shown that compared with the normal population, patients with
reflux disease have a substantial decrement in QOL, such that the
QOL in patients with reflux disease is similar to that in patients with
chronic congestive heart failure.
90% of patients with GERD are effectively managed with medical
therapy including antacids, H2-blockers and the most potent group of the proton pump inhibitors, about 10% of GERD patients fall in the category of surgical requirement to control their symptoms, the introduction of laparoscopy made the surgical approach a very convenient and efficient treatment modality for those patients,
abolishing much of the inconvenience previously met in the open surgery.
The laparoscopic Nissen’s fundoplication procedure provided an
excellent solution for this problem and has been standing against time since the development of this procedure.
A wide range of modifications were offered to improve the efficacy and decrease the morbidity of this operation, one of them was the Rossetti-Hell modification; a highly debatable approach once put in comparison with the original procedure.
In our study, an objective comparison was made between the two procedures focusing on multiple aspects of both procedures to stand on the superiority of each one over the other. We compared data including: subjective results of symptomatic relief (DeMeester’s
score), quality of life (HR-QOL score), operative time, operative
morbidities and complications, post-operative complications and
hospital stay, along with the objective results obtained via upper endoscopy and esophageal manometry.
The study was conducted over 38 patients symptomatic for GERD and indicated for surgery, randomly divided into 2 equal groups, who underwent laparoscopic Nissen and Nissen-Rossetti procedures.
Both procedures were nearly efficient and equal as regards the symptomatic control for the patients, the improvement in their quality of life, healing of esophagitis restoration of the high pressure zone, and post-operative hospital stay, while the Nissen’s procedure was better than the Rossetti’s modification in the aspect of post-operative dysphagia and to a lesser extent gas-bloat syndrome, meanwhile the Rossetti procedure showed significant superiority regarding the
operative time, the incidence of intra-operative bleeding and splenic injury.