A More Sensible Approach for the Management of GERD
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Gastro esophageal reflux disease (GERD) is a common disease due to lower esophageal sphincter (LES) disorder. Herniation represents the main cause of GERD (83.33). In this research, the LES pressure was defective in more than 50% of cases. The main objective treatment of GERD is long-term therapy with potent acid inhibitory drugs. The introduction of minimally invasive surgery (Laparoscopic fundoplication) modulates the strategy towards management of GERD. The risk of recurrence after laparoscopic fundoplication may be due to disruption of crural repair, pillary fasciculation during crural approximation and intrathoracic migration of fundic wrap. In this research the use of double facing fibrin, coated mesh represents a trial to guard against recurrence (prevent pillar fasciculation and disruption). There was reduction of operative morbidity with short hospital stay and early return to normal activity. The symptomatic improvement was 83.3% with consequent endoscopic improvement. Laparoscopic floppy Nissen fundoplication for GERD using double facing fibrin coated mesh is relatively safe with unremarkable complications. It coincides with the concept of tension free repair of hernia all over the body, to bridge large hernial defects without tight approximation of muscle that may result in muscle necrosis and more widening of the defect. The overall cost related to chronic medical management or open antireflux surgical procedures may also be considerably reduced with the use of this laparoscopic approach to antireflux surgery.