الفهرس 
PATIENTS AND METHODSOnly 14 pages are availabe for public view
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Abstract
Gastro-oesophageal reflux disease (GORD) is a significant public health problem, with an estimated 44% of population experiencing at least heartburn occasionally. Up to 10% experience heartburn frequently enough to take medications and those with chronic heartburn can develop complications such as stricture, ulceration associated with bleeding and Barrett’s oesophagus.
It is accepted that in gastro-oesophageal reflux disease, a functional defect of the lower oesophageal sphincter is of major etiologic importance. However, the role of motor abnormalities of the oesophageal body in the pathogenesis and clinical symptoms of (GORD) is poorly understood.
Medical treatment in (GORD) is used to inhibit gastric acid production. Owing to the wide spectrum of pathophysiological mechanisms in (GORD), medical treatment may not prevent gastro-oesophageal reflux, where as, surgery effectively controls the reflux which contributes to its superiority over medical therapy.
A variety of antireflux operations exist for patients with GORD. However, controversy exists with regard to the choice of operation between Nissen (complete) fundoplication and Toupet (partial) fundoplication. Most surgeons operate using the concept of ”tailored approach”.
In view of the still controversial opinions regarding the tailoring concept in the management of GORD we decided to perform this prospective randomized study to evaluate these two antireflux operative techniques in terms of reflux control, dysphagia and healing of oesophagitis, with the exclusion of the preoperative abnormal oesophageal motility, following floppy Nissen versus Toupet fundoplication done laparoscopically.
40 patients with chronic symptoms of gastro-oesophageal reflux disease are studied. The study conducted in the period between Junuary 2007 and Junuary 2009.
All patients were randomized to either laparoscopic Nissen or Toupet fundoplication.
GORD was documented in all patients clinically and by endoscopy according to the Savary-Miller classification of oesophagitis. Clinical evaluation was done after 3 postoperative months.
Early postoperative dysphagia was greater in Nissen than Toupet fundoplication, while postoperative reflux symptoms (heart burn and regurgitation) were greater in the Toupet group, but with no significant statically difference in any of these symptoms.
Beside the clinical satisfaction all endoscopic, manometric studies improved significantly after either procedure with nearly equal results in both groups.