Saurabh S Gandhi, MS, Ajay H Bhandarwar, MS, Chintan B Patel, MS, Amol N Wagh, MS, Priyank D Kothari, Eham L Arora. Grant Government Medical College
Introduction: Gastroesophageal reflux disease is defined as chronic symptoms or mucosal damage caused by abnormal reflux of gastric contents into the esophagus. Chronic GERD is an established risk factor for development of barrets metaplasia. Surgical treatment includes dysphagia, bloating and flatulence(mechanical complications) which might require re-operation. Partial fundoplication has lesser incidence of above symtoms but has a potential for recurrent reflux and thus failure. Mechanical complications in Nissen's fundoplication are associated with a supracompetent high pressure zone (HPZ) which relaxes incompletely on swallowing and is associated with abolition of gas reflux and physiological acid reflux. Partial fundoplication procedures utilise a lesser degree of fundoplication, are associated with a very low incidence of mechanical complications. In the laparoscopic era mechanical complications have overtaken recurrent reflux as principal reason for revisional fundoplication. Our study aims to compare the above 2 procedures in terms of reflux, dysphagia, bloating and flatulence at 6 months from the procedure.
Materials and Methods: 260 patients between the years 2006 to 2016, matched for age, sex, gender ,weight and having reflux evidenced by manometry pressures<10 mm of mercury and 24 hr ph monitoring suggestive of reflux and a normal barium swallow underwent fundoplication. A floppy Nissen's fundoplication was used. Patients were randomized into 2 groups, one undergoing Nissen's and the other partial fundoplication. Post operatively patients were followed up at 1 year .Patients were compared in terms of improvement in reflux scores using baylors reflux symptom index(>13 suggestive of reflux), dysphagia scores, and presence of bloating or flatulence.
Results: 0ut of 130 patients 10 pts(7.7%) in the Nissen's group required reoperation for severe symtoms of dysphagia following which Nissen's fundoplication was taken down and converted into partial fundoplication. out of the remaining 120 patients 77%(92 patients) patients had complete resolution of reflux , 33 % patients(40) had significant dysphagia with 20 % patients(24) had flatulence and bloating.In the partial fundoplication group 85%(110) had improvement in reflux and remaining 15 % patients had persistent symptoms of reflux.The results were analysed statistically .
Conclusion: Partial fundoplication group had equivalent improvement in the symptoms of reflux as compared to Nissen's fundoplication without dysphagia and bloating associated with Nissen's fundoplication. Partial fundoplication procedure is at least as effective and durable in reflux control as Nissen's fundoplication, whilst being associated with lower incidence of mechanical complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79999
Program Number: P623
Presentation Session: Poster (Non CME)
Presentation Type: Poster