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. |
