title: Surgical treatment of benign diseases of the gastroesophageal junction in clinic of endoscopic surgery at MMA during the period 2005-2012: pathophysiology, surgical techniques and trends of their use.
abstract: Treatment of the diseases of the gastroesophageal junction is one of the serious problems faced by gastroenteorologist and surgeons. In contrast to the proton pump inhibitors (PPI) surgery achieves a long symptoms free period. Laparoscopic surgery has its advantages as an alternative to conventional surgery. The purpose of this study was to compare the obtained results from patients treated with laparoscopic surgical methods to the results of the patients treated with conventional surgery and conservative treatment with PPI.
  
  
  METHODS
  The present study includes 99 patients: 90 patients with diaphragmatic hernia and gastroesophageal reflux disease (GERD), 8 patients with achalasia and a benign stricture of the lower third of the esophagus. All patients were operated by laparoscopic techniques. 72% of the 99 patients were women and 28% men. The average age of patients was 62 years.
  
  
  RESULTS
  The majority of our patients had mixed hiatal hernia--55.5%, followed by axial (23.3%) and hiatal (13.3%). The most common method we used was anterior fundoplication (85.5%), we used the Nissen fundoplication in 7.8% of the patients, crurorhaphy with mesh in 4.4% and plain crurorhaphy in 2.2%. All patients had a mild postoperative period. Analgesia with prophenid is done only in the first 24 hr. The average hospital stay of the patients was 3 days.
  
  
  CONCLUSIONS
  Partial laparoscopic fundoplication is a method of choice for the anti-reflux surgery compared to conventional surgery and drug therapy. Dysphagia is rare in patients with anterior fundoplication and is easily influenced by conservative treatment, that's why is our preferred method.
authors.affiliation: Clinic of Endoscopic Surgery, Miltary Medical Academy, Sofia, Bulgaria.
authors.forename: G
authors.initials: G
authors.lastname: Kotashev
authors.forename: K
authors.initials: K
authors.lastname: Vasilev
authors.forename: Pl
authors.initials: P
authors.lastname: Ivanov
authors.forename: Gr
authors.initials: G
authors.lastname: Grigorov
authors.forename: V
authors.initials: V
authors.lastname: Kiossev
authors.forename: V
authors.initials: V
authors.lastname: Hristova
mesh_terms: D004931:Esophageal Achalasia / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome