الفهرس | Only 14 pages are availabe for public view |
Abstract Gastro-esophageal reflux disease is a significant healthcare worldwide disease. Manifestations range from asymptomatic to heart burn, regurgitation and dysphagia, even predispose to barret esophagus. number of physiologic barriers exist preventing reflux from the stomach into the lower esophagus, such as the lower esophageal sphincter, angle of His, and the length of the intra- abdominal esophagus. Treatment options include dietary or behavioral modifications, pharmacologic intervention, and surgical therapy. Laparoscopic Nissen fundoplication is the most popular operation for the surgical management of GERD. modifications were done to help decreasing side effects of nissen fundoplication regarding ligation of short gastric vessels, creation of short wrap rather than long wrap , insertion of mesh or not to close diaphragmatic defect and others. The aim of this clinical trial was to compare both long wrap (3cm) versus short wrap (1.5 cm)techniques on effectiveness of nissen fundoplication . sixty patients presenting with symptomatic hiatus hernia or GERD with failed medical treatment were included in the study. Patients were divided randomly to two groups, thirty cases each. group A for long wrap Nissen cases while group B for short wrap nissen cases. The study comprised 19 males and 41 females. The mean age at time of surgery was 35 years. Heart burn and regurgitation not responding to medical treatment was the most common presenting symptom which was found in nearly all patients. There has been no significant difference in the early post-operative complications except for early bloating that was significantly lower in the short wrap group. The incidence of post-operative dysphagia was low in the both groups. Interestingly, earlier resolution of dysphagia was significantly noticed in the short wrap group. Meanwhile, no significant difference in the recurrence rate could be detected. In conclusion, management of GERD is based on disease severity, the degree of symptoms, and presence or absence of complications determined by diagnostic evaluation. Surgical intervention is offered to those not improving after prolonged pharmacological treatment or developing complications. The results of this study suggest that short wrap nissen fundoplication offers an effective modification to long wrap nissen fundoplication with less bloating and much less dysphagia without affecting its effectiveness on controlling GERD symptoms. |