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 crawl 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. |
