Ahmed Talha1, Mohammed Ibrahim2. 1. Department of Surgery, Medical Research Institute, Alexandria University, 165, Al-Horreya Avenue, Hadara, Alexandria, 21561, Egypt. ahmedtalha047@yahoo.com. 2. Department of Surgery, Medical Research Institute, Alexandria University, 165, Al-Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
Abstract
BACKGROUND: Gastroesophageal reflux disease (GERD) is commonly associated with obesity, and its surgical management is debatable. OBJECTIVE: The objective of this study was to prove the safety and feasibility of laparoscopic Nissen's fundoplication (LNF) combined with mid-gastric plication (MGP) for treatment of obese patients with GERD. METHODS: LNF combined with MGP was done for 18 patients. All interventions were performed under general anesthesia. The follow-up protocol included body mass index (BMI), percentage of excess weight loss (%EWL), percentage of excess BMI loss (%EBMIL), and clinical assessment using the Gastro-esophageal Reflux Health-Related Quality-of-Life (GERD-HRQOL) scale at 6 and 12 months. RESULTS: The period of follow-up ranged from 12 to 33 months with a mean of 17.74 ± 3.73 months. The operation time was 1.40 ± 0.27 h. No serious procedure-related complications occurred. GERD-related symptoms resolved in all patients (p < 0.001). There was a significant improvment in endoscopic findings at 6 months compared to properatively (p = 0.001). There was a significant patient satisfaction score using GERD-HRQOL at 6 and 12 months (p = 0.000). The 1-year follow-up excess weight was significantly less than the baseline excess weight (p < 0.001). The average BMI decreased from 37.59 ± 1.89 kg/m2 at baseline to 30.61 ± 1.57 kg/m2 at 1 year (p < 0.001). CONCLUSIONS: LNF combined with MGP for treatment of obese patients with GERD is technically safe, feasible, and promising with no serious procedure-related complications. The technique is effective in terms of weight loss and cure of GERD. However, future larger studies are required to demonstrate the safety, effectiveness, and long-term durability of the procedure.
BACKGROUND:Gastroesophageal reflux disease (GERD) is commonly associated with obesity, and its surgical management is debatable. OBJECTIVE: The objective of this study was to prove the safety and feasibility of laparoscopic Nissen's fundoplication (LNF) combined with mid-gastric plication (MGP) for treatment of obesepatients with GERD. METHODS: LNF combined with MGP was done for 18 patients. All interventions were performed under general anesthesia. The follow-up protocol included body mass index (BMI), percentage of excess weight loss (%EWL), percentage of excess BMI loss (%EBMIL), and clinical assessment using the Gastro-esophageal Reflux Health-Related Quality-of-Life (GERD-HRQOL) scale at 6 and 12 months. RESULTS: The period of follow-up ranged from 12 to 33 months with a mean of 17.74 ± 3.73 months. The operation time was 1.40 ± 0.27 h. No serious procedure-related complications occurred. GERD-related symptoms resolved in all patients (p < 0.001). There was a significant improvment in endoscopic findings at 6 months compared to properatively (p = 0.001). There was a significant patient satisfaction score using GERD-HRQOL at 6 and 12 months (p = 0.000). The 1-year follow-up excess weight was significantly less than the baseline excess weight (p < 0.001). The average BMI decreased from 37.59 ± 1.89 kg/m2 at baseline to 30.61 ± 1.57 kg/m2 at 1 year (p < 0.001). CONCLUSIONS: LNF combined with MGP for treatment of obesepatients with GERD is technically safe, feasible, and promising with no serious procedure-related complications. The technique is effective in terms of weight loss and cure of GERD. However, future larger studies are required to demonstrate the safety, effectiveness, and long-term durability of the procedure.
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