الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
60 patients, 35 males and 25 ftrilales, suffering from intractable GERD with poor or no response to medical treatmnt,
were included in this study.
All patients were collected fron: Benha university
hospital, Benha insurance hospital, Benha educational hospital
and Police authority hospital since the period from January 1996
to February 1999.
These patients were classified into Group A. Including 32
patients (53.333%) and who were mh’1a.:~edtraditionally using
th. open technique and Group .3. Irduding 28 patients
(47.667%), who were operated upon Japaroscopically forthe
same procedure.
The presenting symptoms were as follows in order of
rlequency: Heart bum (85%), regurgi[atlon (35%), chest pain
(
LI3.333%), epigastric pain (31.667%), d.’·s~hagia (28.333%) and
belching (10%). Endoscopy was done prior to surgery, which
revealed reflux esophagitis among all the included cases. These
patients was graded into Grade 1 (16.667%) Grade 2 (45%).
Grade 3 (23.333%) and Grade 4 (15%). jtny case with stricture
fen-nation, Barret’s esophagus or suspecio. is of malignancy was
ex~luded from this study.
Hiatus hernia, confirmed by barium study, was found
ar iong 75% of cases. While gall stones, detected by abdominal
ult’asonography, was found in 35%.
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--- .__ ~ummary & Conclusion
Preoperative esophageal manon~et(:’y and ambulatory 24
hour pH monitoring was done to all patients revealing lower
E.S pressure: >10 mmHg in(53.125% & .’j0%), 6-10 mmHg in
(34.375 & 42.857) and <6mmHg in (12.5 & 7.143) of patients in
both groups respectively. Also, residual relaxation pressure
wase:2-3 mmHg in (28.125 & 28.571%), 1-2 mmHg in
(15.625% & 25%) and <lmmHg in (56.25% & 46.429%) of
patients in both groups respectively. Esophageal body function
was normal in all patients.
Same surgical procedure was followed in both groups A &
B, Floppy Nissen fundoplication, anc on comparing operative
data gained from both groups respectively, the results gained
WB;;eas follows : The mean operative time 93 & 125 minutes,
meanperiod of hospital stay 7.8 and’; ’5 (lays..
The study of post operative ccnplkations in both groups
revealed the following: Chest infection 12.5% & 10.714%
wound infection 12.5% & 7.148%. Incisional hernia 6.25% &
0%. And pneumothorax 0% & 3.571% . ’There was no mortality
among both groups.
Symptomatic improvement gainer. by surgery in both
groups during one year follow up regulated 1 month, 3,6 and 12
months postoperatively, was as follows respectively; (28.125%
& 35.714%), (46.875% & 64.285%)’, (fn.25% & 71.42%) and
(81.375% & 82.143%).
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225
Summary & Conclusion
Endoscopic mucosal impnt\’ement .was recorded
throughout the same schedule in both groups respectively;
(6.25% & 3.571%), (21.875 % & 28517%), (37.5 & 42.857%),
and (40.62% & 46.428%).
Postoperative morbidity in bot}, groups, were recorded
respectively as follows: Dysphagia; 12.5% & 10.714%, gas
bloat syndrome; 15.625% & 21~29%, nausea; 6.25% &
10.714%, diarrhea; 3.125 &3.57PIo and persistance of
respiratory symptoms; 15.625%& 1.1.266%.
On comparing the results g.iinecl~romboth groups, there
were no statistical difference between both groups denoting that
such procedure, Nissen fundoplication with relatively low
complications and morbidity, can be ~otlsideredas a satisfactory
method for controlling GERD, especially if the advantages of
minimally invasive technique are added for the sake of patients.
CONCLUS10N
We conclude from this study that:
- Heartburn and regurgitation are thevnost frequent symptoms
of GERD as they are considered to he the typical symptoms
of reflux.
- The presence of regurgitation indicates more sever disease.
- The future for 24 hour pH esoonaseal monitoring is bright,
as it has the potential to do for I~hediagnosis of GERD what
endoscopy has done for the diagnosis of peptic ulcer.
- LES pressure hypotonia has a major role in the pathogenesis
ofGERD ..
226
Summary & Conclusion
- Both the frequancy and duration c·h::,ophageal acid exposure
are the most common factor, determinmg the development of
reflux esophagitis.
- The Nissen fundoplication has been shown to be an effective
means of attaining mucosal hea’~n.!;·usually accompanied by
symptomatic relief. The use of ”ioose wrap” performed over
a large bore dilator avoids the rost-operative complications
such as dysphagia and gas bloat.
- Laparoscopic .Nissen fundoplication combines the efficacy of
the well established Nissen procedure with advantages of
minimally invasive technique in the treatment of patients with
severe gastroesophageal reflux (J.scase. When this procedure
is performed by an experienced hand, the technique IS
extremely safe and associated With t’ high success rate.
RECOMMENDATION
1.Any patient with GERD not responding to medical treatment
.better to shift to surgery to avoid permanent esophageal
mucosal changes.
2. Esophageal manometry and pH 11f.”Jdshyould be done to all
patients before surgery to ensure tlse surgical Success. 3. Laparoscopic or conventional Nissen’s fundoplication
shows equalpostoperative resuhs..