Short and Long Term Results Of Laparoscopic Total Fundic Wrap (Nissen) or Semifundoplication (Toupet) for Gastroesophageal Reflux Disease.

摘要

introduction: Gastroesophageal reflux disease (GERD) is a common upper GIT disorder. The choice of surgical management options is debatable between laparoscopic Nissen fundoplication (LNF) and Toupet fundoplication (LTF) especially in cases with esophageal dysmotility.Patients and methods/Aims: 102 patients with chronic GERD divided into 2 groups. Group (1): Patients with good peristalsis (n=70) done LNF. Group (2): Patients with poor peristalsis (n=32) patients done LTF to compare the outcome. They were included in this study. They subjected to clinical, radiological and esophageal motility investigations.Results: In postoperative period, Recurrent of heartburn, dysphagia and abdominal distension were found in 5.71%, 14.28% and 27.14% post LNF and in 9.37%, 15.62% and 15.62% post LTF respec tively. Pre operative LESP was 10.16 5.4 mmHg in LNF 8z 9.56 3.51 mmHg in LTF group increased to 20.7 7.84 mmHg early after LNF (p<0.0001) & 15.26 6.47 early after LTF (p = 0.0002). Esophageal 24hrs pH inetry in early and late post operative showed a significant improvement of % reflux (p < 0.001)10 both groups. Conclusion: Toupet fundoplication became the procedure of choice of cases with esophageal dysmotility due to its ease of application, patient satisfaction, low dysphagia rate and low levels of abdominal distension.