الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The aim of this study is to assess the indications, contraindications, ideal technique and complications of laparoscopic Nissen fundoplication as well as its effectiveness in controlling symptomatic GERD.
In conclusions these data suggest that properly constructed Nissen fundopliation can achieve significant improvement of all GERD symptoms but asthma. Despite being technically demanding, the procedure can be safely performed using the laparoscopic approach regardless of the oesophagitis severity or associated large HHs with no mortality, and limited need for conversion or reoperation. Additionally, it offers the typical advantages of MIS including shorter hospital stay, less need for pain medication, quicker return to normal activities and minor scars. However, the procedure is not devoid of morbidity and serious complications may arise in the preoperative setting especially in the presence of adhesion including; perforation, bleeding, pneumothorax and acute wrap herniation. Also, a suitable proportion of patients will possibly have side effects including persistent dysphasia, bloating and diarrhea. With careful patient selection, restriction of the procedure to patients with adequate esophageal body motility, and adherence to technical details including routine SGVs division and adequate crural closure, the risk of side effects can be minimized and excellent patient satisfaction can be achieved. Patients with adequate preoperative response to PPI inhibitor therapy are more likely to get a favorable outcome. The presence of DGE doesn’t adversely affect the outcome of Nissen fundopliation; however patients with marked delay in gastric emptying should be offered pyloroplasty with fundoplication to ensure adequate gastric drainage. As surgeons gain higher degrees of competence, better results can be achieved. Successfully performed procedure could possibly have a protective effect against the progression of BE to dysplasia or cancer.