title: Laparoscopic Nissen Fundoplication: Analysis of 162 patients.
abstract: METHODS
  One hundred and sixty-two patients with GERD were treated surgically with LNF from October 2006 to March 2010. Diagnoses were made by using upper gastrointestinal system (GIS) endoscopy and 24-hour pH monitoring, and all the patients underwent routine LNF surgery. The patients were questioned regarding complaints and proton pump inhibitor (PPI) usage during the postoperative period, and forty patients who had postoperative GIS symptoms were included. Upper GIS endoscopy with antral biopsy for Helicobacter pylori (HP) identification and multichannel intraluminal impedance pH(MII-pH) monitoring were applied Results:The median postoperative follow-up time was 1.84 Â± 0.850 (0.29-3.48) years. PPI treatment frequency was 37.5% (15 patients) in the 40 symptomatic 40 patients, or 9.26% in all 162 patients who were operated on. The reason for PPI usage in three patients (7.5%) was regarded as recurrence. HP positivity was 67.5% in the symptomatic patients and 73.3% in the PPI treated group; 40% (six patients) recovery was achieved in the HP (+) patients by using an HP eradication treatment protocol. The operated patients displayed statistically significant results in increased quality of life (p = 0.001) and lowered DeMeester scores (p = 0.000) during the postoperative period when compared to preoperative period.
  
  
  CONCLUSIONS
  PPI treatment alone during the postoperative period does not indicate recurrence. One of the most important reasons for recurrence is antral gastritis secondary to HP infection; PPI usage diminishes remarkably with an HP eradication protocol. MII-pH monitoring is an effective method of determining recurrences due to reflux and their types in postoperative symptomatic patients.
authors.affiliation: 1 Department of General Surgery Kocaeli Seka State Hospital, Kocaeli, Turkey.
authors.forename: Alpaslan
authors.initials: A
authors.lastname: SarÄ
authors.affiliation: 2 Department of General Surgery, Kocaeli University, School of Medical, Kocaeli, Turkey.
authors.forename: Neset
authors.initials: N
authors.lastname: Gonullu
authors.affiliation: 3 Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors.forename: CagrÄ
authors.initials: C
authors.lastname: Tä Ryaki
authors.affiliation: 4 Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: YazÄ cÄ Oglu
authors.affiliation: 5 Abant Izzet Baysal University,Schhol Of Medicine.
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Kargi
authors.affiliation: 6 Department of General Surgery Eskisehir State Hospital, Eskisehir, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Gonullu
authors.affiliation: 7 Department of General Surgery, Kocaeli University, School of Medical, Kocaeli, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yä Rmibesoglu
keywords: Laparoscopic Nissen fundoplication, PPI treatment, multichannel intraluminal impedance