الفهرس 
? Surgical anatomy of stomachOnly 14 pages are availabe for public view
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Abstract
Gastro-esophageal reflux disease is a significant healthcare
worldwide disease. Manifestations range from asymptomatic to heart
burn, regurgitation and dysphagia, even predispose to barret
esophagus. number of physiologic barriers exist preventing reflux from
the stomach into the lower esophagus, such as the lower esophageal
sphincter, angle of His, and the length of the intra- abdominal
esophagus.
Treatment options include dietary or behavioral modifications,
pharmacologic intervention, and surgical therapy. Laparoscopic Nissen
fundoplication is the most popular operation for the surgical management
of GERD. modifications were done to help decreasing side effects of
nissen fundoplication regarding ligation of short gastric vessels, creation
of short wrap rather than long wrap , insertion of mesh or not to close
diaphragmatic defect and others.
The aim of this clinical trial was to compare both long wrap (3cm)
versus short wrap (1.5 cm)techniques on effectiveness of nissen
fundoplication .
sixty patients presenting with symptomatic hiatus hernia or GERD
with failed medical treatment were included in the study. Patients were
divided randomly to two groups, thirty cases each. group A for long wrap
Nissen cases while group B for short wrap nissen cases. The study
comprised 19 males and 41 females. The mean age at time of surgery was
35 years. Heart burn and regurgitation not responding to medical treatment
was the most common presenting symptom which was found in nearly all
patients.
There has been no significant difference in the early post-operative
complications except for early bloating that was significantly lower in the
short wrap group.
The incidence of post-operative dysphagia was low in the both
groups. Interestingly, earlier resolution of dysphagia was significantly
noticed in the short wrap group. Meanwhile, no significant difference in the
recurrence rate could be detected.
In conclusion, management of GERD is based on disease severity,
the degree of symptoms, and presence or absence of complications
determined by diagnostic evaluation. Surgical intervention is offered to
those not improving after prolonged pharmacological treatment or
developing complications.
The results of this study suggest that short wrap nissen fundoplication offers an effective modification to long wrap nissen fundoplication with less bloating and much less dysphagia without
affecting its effectiveness on controlling GERD symptoms.