Role of laparoscopic fundoplication in the management of gastro-esophageal reflux disease: An evidence-based appraisal
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Hellenic Journal of Surgery (2016) 88:6, 391-397
Role of Laparoscopic Fundoplication in the Management of Gastro-Esophageal Reflux Disease: An Evidence-based Appraisal Nikhil Gupta, Nitin Agarwal
Abstract Gastro-esophageal reflux disease (GERD) is a very common medical disease. There is no consensus for optimal management of GERD. Proton pump inhibitors (PPI) are the most effective drug treatment for GERD. The number of antireflux procedures is on the rise, partly due to increased patient’s expectations, and partly due to the advancements in minimal access surgery. There are few controversies surrounding role of laparoscopic fundoplication in the management of GERD, like whether surgery is superior to PPI; which modality is better, laparoscopic or open; whether complete wrap is better than partial, and whether division of short gastric vessels provides any advantage or not. This review article was undertaken to evaluate the role of laparoscopic fundoplication in the management of GERD and to find out answers to these controversial questions. Key words: Gastro-esophageal reflux disease (GERD); proton pump inhibitors (PPI); laparoscopic nissen fundoplication
(LNF); short gastric vessels (SGV)
Introduction Gastro-esophageal reflux disease (GERD) is a very common medical disease. Normal competence of GE junction is maintained by lower esophageal sphincter (LES), which is influenced by its anatomical location in relation to diaphragm and its physiological function. The classic triad of symptoms of GERD is retrosternal burning pain (heartburn), epigastric pain and regurgitation. It is the most common condition affecting the upper GIT in western world. This is partly due to decreased incidence of peptic ulcers along with rising incidence of GERD in last 2-3 decades; incidence of peptic ulcer has decreased due to improved socioeconomic conditions leading to better control of H pylori infection. The strong association between GERD, obesity and the parallel rise in incidence of adenocarcinoma of lower third of esophagus is a major health concern today [1]. There is no consensus for optimal management of GERD. Proton pump inhibitors (PPI) are the most effective drug treatment for GERD. The number of antireflux Nikhil Gupta MS, MRCSEd, FAIS, FMAS, FIAGES, MNAMS Associate Professor Nitin Agarwal MS, FIAGES, MNAMS Associate Professor Department of Surgery, PGIMER Dr RML Hospital, Delhi, India Corresponding author: Dr Nikhil Gupta MS, MRCSEd, FAIS, FMAS, FIAGES, MNAMS, Associate Professor, Department of Surgery, PGIMER Dr RML Hospital, Delhi-110001, India Tel.: 91-011-45526090, e-mail: [email protected] Received 8 August 2016; Accepted 27 Sept 2016 Hellenic Journal of Surgery 88
procedures is on the rise, partly due to increased patient’s expectations and partly due to the advancements in minimal access surgery. Few pertinent questions need to be answered regarding optimal management of GERD. 1. Which modality is better; medical or surgical? 2. Is laparoscopic fundoplication superior to open approach? 3. Has Laparoscop
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