Objectives: To determine the burden of gastroesophageal reflux disease
(GERD) on patients' quality of life (QOL) and the extent of change
imposed by GERD laparoscopic surgical correction.
Patients & Methods: The current study included 52 patients presenting
with symptomatic GERD that was not adequately controlled with medical
treatment. After clinical examination, all patients underwent upper
gastrointestinal endoscopy, esophageal manometry to estimate lower
esophageal sphincter (LES) pressure and were asked to complete the
items of the gastroesophageal reflux disease impact scale (GIS)
questionnaire and total score was calculated. Laparoscopic hiatal defect
closure through crural approximation using stitches and circumferential
placement of polypropylene mesh fixed to both crura, and then 3600
fundoplication was performed. Operative and postoperative (PO) data
were collected. GIS questionnaire and esophageal manometry were
repeated 8-weeks and 6 months PO, respectively.
Results: All patients passed smooth intraoperative course without
complications or need for laparotomy. Mean operative time was
60.9±12.6 minutes, mean time till 1St ambulation and oral intake was
5.4±1.2 hours and 9.5±1.2 hours, respectively. Mean duration of hospital
stay was 27.7±9.8 hours and mean duration till attaining full daily activities was 6.8±2.4 days. All patients showed significant improvement
of the individual items of GIS questionnaire compared to preoperative
scores with significantly higher total PO score compared to preoperative
total score. PO manometeric measurements of LES pressure were
significantly higher compared to preoperative pressure measures.
Conclusion: Laparoscopic anti-reflux surgery (LARS) with mesh repair
of hiatal hernia is a safe and effective procedure for management of
GERD with significant improvement of patients' QOL.
Keywords: Laparoscopic anti-reflux surgery, Gastroesophageal reflux
disease, Quality of life |
