Complete versus non-complete fundoplication in surgical treatment of gastroesophageal reflux disease

Abstract

Gastroesophageal reflux disease is a common disorder accounting for approximately 75% of esophageal pathology. It seriously compromises quality of life. It develops when the reflux of gastric content causes troublesome symptoms or complications. During the last decades significant changes have occured in the role of surgery for gastroesophageal reflux disease. Initially antireflux surgery was reserved only for patients who had failed any kind of medical therapy. Now the range of indications for antireflux procedures is wide. Operations for gastroesophageal reflux disease are now well established and have good short- and long-term results, but no unique laparoscopic antireflux technique has been accepted so far, and a number of different antireflux procedures with numerous modifications have been reported. A total of 102 consecutive patients with gastroesophageal reflux disease were operated in the clinic of Republican Medical Center ‘’Armenia’’ (Yerevan, Armenia) and Mickaelyan Institute of Surgery (Yerevan, Armenia) from 2010 to 2021. In all cases the esophagogram showed hiatal hernia. Nissen, Nissen-Rossetti and Toupet fundoplications were performed as antireflux procedures. In all cases of combination of hiatal hernia and Gastroesophageal reflux diseasemesh reinforcement was performed. The results of follow-up assessment of the operated patients were compared. The results in early postoperative period were assessed with contrast X-ray examination and 24-hour pH-metry on the 5-th to 7-th days after surgery. The quality-of-life evaluation by the questionnaire showed a significant difference between the two groups, improvement of results in the laparoscopy group with complete fundoplication in comparison with not complete fundoplication. Complete fundoplication is a more reliable method of antireflux procedures for surgical treatment of gastroesophageal reflux disease. The division of short gastric vessels helps to prevent persistent dysphagia. The repair of esophageal hiatus of diaphragm is mandatory in antireflux procedures.