M.UMIT UGURLU, MD, ILKNUR ERGUNER, MD, S.YIGIT YILDIZ, MD, ZEHRA BOYACIOGLU, MD, KURSAT CETIN, MD, M.TAHIR ORUC, MD. Kocaeli Derince Teaching and Research Hospital, Kocaeli, Turkey
Introduction: Recent inventions in endoscopic techniques brought out advancements in treatment of gastroesophageal reflux disease (GERD). We analysed our laparoscopic nissen fundoplication (LNF) procedures that we performed in our clinic in terms of peroperative features of the cases.
Methods: LNF was performed between January 2009-September 2010 in Kocaeli Derince Teaching and Research Hospital for 24 patients having GERD symptoms, osephagitis with/without Barrett, hiatal hernia and De Meester score above normal (normal value:14.72) in 24 hour pH monitorization. Patients were reanalysed after 1 month postoperatively; endoscopy and pH monitorization were held out for ones having reflux symptoms and dysphagia.
Results: Fifteen female (61%) and 9 (39%) male patients with diagnosis of GERD were operated. Their mean age was 41.9 ± 9.05 (32-63) and their mean body mass index was 26.17 ± 3.61 (19-32). Mean De Meester score of the patients was 45.09 ± 22.69 (15.52 – 160.49). According to duration of GERD symptoms patients had complaints for 5.82 ± 6.62 (1-20) years in avarage. Preoperative endoscopic examination revealed that 21 (87%) patient had esophagitis and 13 (54%) patient had hiatal hernia. When the operative choices were interpreted, 8 (33%) patient had Nissen fundoplication-cruroplasty-mesh repair, 2 (8%) had Nissen fundoplication-cruroplasty and 14 (59%) had Nissen fundoplication procedures. Mean operation time was 53.85 ± 17,23 (35-120) minutes. Laparotomy was done for 3 (11.6 %) patients due to operative adversities: Esophageal perforation occured in one patient, other patient had subcutaneous emphysema and pneumothorax, we faced diffucilties in surgical dissection in the other. Mean hospital stay was 2.62 ± 1.57 (2-7) days and drains were kept for 2.08 ± 0.82 (1-4) days in avarage. In postoperative period 2 patient had pulmonary emboli and one had pneumonia. These patients had Factor V Leiden mutations and their mean BMI was 25 ± 5.3. Two other patients had active bleeding from drains, bleedings stopped spontaneously in 24 hours. Three patient described nonspecific symptoms and two patient suffered from dysphagia postoperatively. We performed gastroscopy for these patients and we detected loose fundoplication in one of them. This patient also had high De Meester score. Proton pump inhibitors were prescribed and their symptoms disappered. Two of these patients had also positive results for Helicobacter Pylori. We observed no peroperative mortality.
Conclusion: LNF became gold standart in treatment of GERD. For operative decision there must be a single objective sign concomitant with typical reflux symptoms. Our results correspond with the recent literature and we observed that LNF procedure is being held out safely in our clinic.
Program Number: P457