الفهرس 
Table of ContentsOnly 14 pages are availabe for public view
 |  | from | 150 |  |  |
| | | from | 150 | | |
Abstract
Diaphragmatic relaxing incisions reduce hiatal tension (9, 30) and facilitate primary hiatal closure. Diaphragmatic relaxing incisions were developed to reduce tension at the hiatus and facilitate a primary tension-free closure of the complex hiatus. In patients with elevated hiatal tension, one would expect relaxing incisions to reduce hiatal hernia recurrence to a rate similar to that seen in patients who undergo primary hiatal closure with minimal or no tension. This prospective randomized study was conducted at Gastrointestinal Surgical Center, Mansoura University aiming to compare the short-term outcome of right crural relaxing incision associated with laparoscopic fundoplication versus laparoscopic Nissen fundoplication only as a treatment for hiatus hernia as regards recurrent hernia, migration of wrap, quality of life, conversion rate, postoperative morbidity, and hospital stay. We included a total of 70 cases who were randomly allocated into two groups; the crural relaxing group with laparoscopic Nissen fundoplication (35 cases) (group A), and laparoscopic Nissen fundoplication only (35 cases) group B). All cases were subjected to history taking, clinical examination, and routine laboratory investigations. In addition, Pelviabdominal ultrasound, barium study, esophageal manometry, 24-hour pH monitoring and upper endoscopy was ordered for all cases. Intraoperative events were recorded, and post-operative follow up included the same preoperative investigations along with assessment of quality of life improvement. Our results showed that: There was no significant difference between the two groups regarding demographic characteristics. Sliding HH was the commonest cause in both groups (74.3% and 85.7% of cases respectively), followed by mixed HH (20% and 11.4% of cases respectively), while the remaining cases had paraesophageal HH. No significant difference between the two groups regarding preoperative and one year follow up Rome GERD. However, it showed a significant improvement in group A in the first month and six months follow up visits. There was no significant difference between the two groups regarding either of the reported preoperative symptoms. On post-operative follow up, there was a significant difference between the two groups, as the prevalence of these symptoms showed a significant increase in the group B compared to group A. Barium findings showed no significant difference between the two groups before operation. During follow up visits, one case with recurrent hernia was diagnosed in group A. Endoscopic findings showed no significant difference between the two groups before operation. One year follow up showed the superiority of the crural relaxing incision as endoscopy revealed normal findings in 94.2% and 77.1% of cases in the two groups respectively. No significant difference was noted between the two groups as regard preoperative endoscopic GERD class. Follow up visits also showed no significant difference between the two groups. CONCLUSION: It was evident that crural relaxing incision is safe, and feasible for reducing tension. It allows approximation of crura with significantly better post-operative outcomes regarding symptom improvement, drug dependence, quality of life and recurrence rates.