title: Laparoscopic Nissen fundoplication is an excellent modality for GERD: early experience from a tertiary care hospital in India.
abstract: BACKGROUND
  Surgical management for gastroesophageal reflux disease (GERD) is indicated for reflux uncontrolled on medical therapy. Few studies have been reported from the Indian subcontinent evaluating laparoscopic fundoplication in GERD. The study was designed to evaluate laparoscopic Nissen fundoplication (LNF) in proven cases of GERD and to evaluate the procedure from using detailed symptomatic, objective parameters.
  
  
  METHODS
  Forty-nine patients symptomatic for GERD and with esophagitis on endoscopy were included in the study. Symptoms were evaluated by DeMeester's score (DS) and modified Visick grade (MVG). All patients underwent an upper gastrointestinal endoscopy with biopsy, ultrasound abdomen, Barium swallow, esophageal manometry, and 24-hour pH metry. Twenty-five of 49 patients showing reflux on 24-hour pH metry underwent LNF. They were followed-up postoperatively at 1, 3, and 6 weeks. Esophageal manometry and 24-hour pH metry were repeated at 6 weeks. The data were compared from using Wilcoxon signed rank test, the Student's t-test, and Spearman's correlation coefficient.
  
  
  RESULTS
  At 6 weeks postoperatively, percentage time with esophageal pH <4 decreased from 10.18% preoperatively to 0.85%. Length of lower esophageal sphincter (LES), length of intra-abdominal part of LES and LES pressure at the respiratory inversion point increased significantly from 2.08 cm, 0.85 cm, and 7.82 mm Hg to 3.36 cm, 2.13 cm, and 22.00 mm Hg, respectively. Median DS and MVG decreased from 4.00 and 3.35 preoperatively to 0 and 1, respectively. There was no conversion to open surgery and no mortality. Five patients developed temporary dysphagia to solids, which was relieved before 6 weeks postoperatively. Mean time to return to work was 12.60 days.
  
  
  CONCLUSIONS
  LNF proved highly effective in the management of Indian patients with GERD who have failed medical therapy and provides significant symptomatic improvement postoperatively with a low incidence of side effects.
authors.affiliation: Division of Minimal Access Surgery, Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India. profplal@gmail.com
authors.forename: Pawanindra
authors.initials: P
authors.lastname: Lal
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Nitin
authors.initials: N
authors.lastname: Leekha
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chander
authors.forename: P
authors.initials: P
authors.lastname: Kar
authors.forename: V K
authors.initials: VK
authors.lastname: Ramteke
mesh_terms: D000328:Adult; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007194:India; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D055815:Young Adult