Laparoscopic Fundoplication for Gastro-esophageal Reflux Disease and Hiatus Hernia: A Short Term Outcome of First 8 Cases

Abstract

Background: Acute gastro-esophageal reflux disease is a common ailment in kashmiri population. Most of these patients are managed by gastroenterologist, physicians and surgeons in daily outpatient basis. Majority of them settle by medical management with the help of proton pump inhibiters, prokinetics and antacids., laparoscopic Nissen’s fundoplication (LNF) is currently the procedure of choice for the surgical management of GERD. Aims and Objectives: The aim of this study was to know the feasibility of laparoscopic fundoplication for hiatus hernia and acute gastro-esophageal reflux disease in terms of operative time, post operative pain, length of hospital stay, conversion rate and recurrence of symptoms. Materials and Methods: The present prospective observational study was conducted in the Post-Graduate Department of General Surgery and minimal access surgery Government Medical College Srinagar from June 2013 to June 20117. The patients that were included in the study had symptomatic gastro-esophageal reflux (documented by endoscopy) with either persistent symptoms despite adequate and prolonged medical treatment, CT documented hiatus hernia and patients, who wanted to avoid long-term medical treatment. The duration of reflux symptoms ranged from 9 months to 30 years (median 6 years). Patients who were excluded from the study were those unfit for anesthesia. Informed consent was taken before surgery in the language, the patients understood. Results: This study includes 8 patients, with median age of 40 years (range 20-70 years). In the study group, 5 were males and 3 were females. The mean operative time was 90 minutes (range 60 t0 120 minutes). There were no major intra operative and post operative complications. The post operative pain was minimal as compared to open surgery. The median hospital stay was 3.5 days (range 3 -6 days). Two patients developed symptoms of bloating, early satiety, nausea and diarrhea. However these symptoms improved within weeks with a good response to appropriate medication. The median time until normal physical activity resumed was 2 weeks (range 3 days to 4 weeks). Median follow-up was 6 months (range1-12 months). The overall short-term results in appropriately selected patients were excellent. The recurrence of symptoms was not observed in any patient within follow up of 6 months. Conclusion: We conclude from our early series of 8 cases, that patients having long standing GERD not responding to medical management who are at a threat to develop barrettes esophagus should be given the benefit of laparoscopic fundoplication. However proper evaluation, patient selection is mandatory. The choice of fundoplication should be dictated by the surgeon’s preference and experience. Currently, the main indication for laparoscopic fundoplication is represented by PPI-refractory GERD, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained by impedance-pH monitoring.