Role of Laparoscopic Fundoplication in the Management of Gastroesophageal Reflux Disease- A Retrospective Study

Abstract

Introduction: Gastroesophageal Reflux Disease (GERD) is a common gastrointestinal disease affecting 3-7% of Asians and becoming a major health care burden in elderly population. Surgical intervention with laparoscopic fundoplication is the effective tool in the management of GERD. Aim: To evaluate the role and advantages of laparoscopic fundoplication in the management of cases with GERD and to compare the laparoscopic Nissen’s fundoplication and laparoscopic toupet’s fundoplication in management of GERD. Materials and Methods: The present retrospective and prospective study was conducted in the Department of General surgery at Government Medical College, Nizamabad from August 2019 to July 2021. A total of 36 cases of both sexes, clinically diagnosed as chronic GERD undergone laparoscopic Nissen’s fundoplication and laparoscopic toupet’s fundoplication surgery were recruited. Preoperative and postoperative assessment of disease status was done at the end of third month and sixth month. Collected data was analysed by using Statistical Package for Social Sciences (SPSS) version 16.0. The chi- square test was used to test the significance of qualitative data. The p<0.005 was considered as statistically significant. Results: In total data collected for 36 cases, majority cases were between 31-40 years (n=13) and 41-50 years (n=11). Total of 19 patients had undergone Laparoscopic Nissen's Fundoplication while 17 patients were of Laparoscopic Toupet's Fundoplication surgery. The mean difference of age was statistically not significant (p>0.05). Postsurgical significant improvement was observed in cases of grade 3 (n=7), grade 4 (n=19) and grade 5 (n=10) oesophagitis. The mean duration to start oral liquids was 1.29 days and 1.08 days, mean duration of surgery was 3.62 hours and 3.19 hours, mean duration of hospital stay was 4.12 and 3.67 days and the average ambulatory period was 1.46 and 1.62 days in laparoscopic nissen’s group and laparoscopic toupet’s group, respectively. Conclusion: The laparoscopic toupet’s fundoplication and laparoscopic nissen’s fundoplication were comparable in the management of postoperative Complications. The incidence of postoperative dysphagia was comparatively more in laparoscopic Nissen’s group than laparoscopic toupet’s group. However, the incidence was diminished within six months of postoperative follow-up.