Benha University
Abstract
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 360o 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
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