Conventional Laparoscopic Nissen Fundoplication versus Rossetti’s Modification in Management of GERD; A Comparative Study

Abstract

Abstract Background gastroesophageal reflux disease (GERD) is increasingly prevalent and costly, and it may affect as much as 20% of the western population. The pathophysiology of GERD is not due to acid overproduction but rather mechanical dysfunction centered around the lower esophageal sphincter (LES). Furthermore, the mainstay of GERD treatment, proton pump inhibitors (PPIs), have come under scrutiny because of worrisome side effects. Aim of the Work to prospectively compare between laparoscopic Nissen fundoplication and its Rossetti’s modification as anti-reflux procedures along with their operative and post-operative outcomes. Patients and Methods this is a prospective randomized study that was conducted on twenty (20) patients presenting to Ain-Shams University Hospitals in whom fundoplication was indicated for management of chronic GERD and was operated upon starting October 2016 to October 2018 with minimal follow up duration of one year. Results both procedures were nearly efficient and equal as regards the symptomatic control for the patients, the improvement in their quality of life, healing of esophagitis restoration of the high pressure zone, and post-operative hospital stay, while the Nissen’s procedure was nearly similar to the Rossetti’s modification in the aspect of post-operative dysphagia and gas-bloat syndrome, the modified Rossetti procedure showed significant superiority regarding the operative time, the incidence of intra-operative bleeding and splenic injury. Conclusion the Rossetti procedure carried better results in the operative time, operative bleeding and splenic injury though it showed nearly no difference in incidence of post-operative dysphagia.