الفهرس 
Anatomy and Physiology of the Esophagogastric JunctionOnly 14 pages are availabe for public view
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Abstract
Gastro-esophageal reflux disease (GERD) is a common disease with increasing incidence. Therapy includes anti-secretory medications and anti-reflux surgery (ARS). Preoperative workup includes pH testing, upper endoscopy, esophageal manometry and radiological assessment.
Although the reason behind the decrease in anti-reflux operations noted over the last decades seems multifactorial, one possible explanation is the fear of short-term adverse effects such as re-herniation and need for reoperation as well as long-term side effects like dysphagia and gas-bloat syndrome.
Studies have shown excellent patient satisfaction after Nissen fundoplication. Although early postoperative dysphagia is relatively common, in most patients it resolves by 2–6 weeks postoperatively. However, in some series up to 25% of patients required endoscopic dilation or reoperation.
The laparoscopic Nissen fundoplication is the gold standard anti-reflux operation, but questions regarding specific technical details are still widely debated: full versus partial fundoplication, mesh versus no mesh, bougie versus no bougie.
The goal of each modification is to maximize reflux control while simultaneously minimizing adverse outcomes such as dysphagia, use of an esophageal bougie decreased the long-term incidence of dysphagia after fundoplication, which has led the majority of surgeons to perform the wrap over a bougie. However, the reported rate of bougie complications is around 0.5% to 1.0% and can result in serious morbidity.
The current literature lacks any evidence on the most appropriate size of bougie that can decrease the incidence of postoperative complication in patients who are undergoing Nissen fundoplication for GERD.
This cross-sectional study was conducted at Ain Shams University Hospital between December 2021 and May 2022 to compare the post-operative complications based on the size of bougie used during Nissen fundoplication for patients diagnosed with GERD.
Twenty patients diagnosed with GERD were enrolled and randomized into two equal groups; group A “bougie size 40 French” and group B “bougie size 52 French”. Any perioperative related complications were documented and correlated to the size of bougie. Patients were seen in clinic 3 to 4 weeks after their operation for their postoperative check. All patient charts were reviewed for an upper endoscopy specifically for dysphagia and/or dilation within 6 months after surgery.
Regarding post-operative complications between two study groups, patients in group (B) had nausea and heart burn recurrence more than group (A) , patients in group (A) had gas bloating more than group (B) and each study group had the same number of patients who had vomiting without any significant difference between two study groups at any symptom as p-Values were (>0.05).
According to eckardt score assessment pre- and post-operatively between two study groups, it was more pre-operative and in 4 months follow up in group (B), it was more and in 2 weeks and 2 months follow up in group (A) and was the same in 1 month follow up without significant difference between two groups at any time point of follow up as p-Values were (>0.05).
Finally, according to eckardt score assessment pre- and post-operatively within two study groups, it was less post-operative than pre-operative with significant difference pre and post-operatively within each group as p-Value was (<0.05).
The strengths of current study were due to it was the first clinical trial assessed the post-operative complications based on the size of bougie used during Nissen fundoplication for patients diagnosed with GERD. All clinical assessment, surgical interventions and assessment of study outcomes were done by the same team. Every effort was made to ascertain that all follow-up data were documented, and only complete information was included in data analysis.
The limitations of current study were due to blinding of the observer wasn’t performed. Relatively small sample size regarding accuracy of study outcomes and COVID 19 pandemic.