Laparoscopic Fundoplication for Gastro-esophageal Reflux Disease and Hiatus Hernia: A Short Term Outcome of First 8 Cases

Main Article Content

Mushtaq Chalkoo
Zahid Mohd Rather
Ferkhand Mohiuddin
Aabid Rasool Bhat
Imtiyaz Ahmad Ganie
Syed Shakeeb Arsalan


Background: Acute gastro-esophageal reflux disease is a common ailment in kashmiri population. Most of these patients are managed by gastroenterologist, physicians and surgeons in daily outpatient basis. Majority of them settle by medical management with the help of proton pump inhibiters, prokinetics and antacids., laparoscopic Nissen’s fundoplication (LNF) is currently the procedure of choice for the surgical management of GERD.

Aims and Objectives: The aim of this study was to know the feasibility of laparoscopic fundoplication for hiatus hernia and acute gastro-esophageal reflux disease in terms of operative time, post operative pain, length of hospital stay, conversion rate and recurrence of symptoms.

Materials and Methods: The present prospective observational study was conducted in the Post-Graduate Department of General Surgery and minimal access surgery Government Medical College Srinagar from June 2013 to June 20117. The patients that were included in the study had symptomatic gastro-esophageal reflux (documented by endoscopy) with either persistent symptoms despite adequate and prolonged medical treatment, CT documented hiatus hernia and patients, who wanted to avoid long-term medical treatment. The duration of reflux symptoms ranged from 9 months to 30 years (median 6 years). Patients who were excluded from the study were those unfit for anesthesia. Informed consent was taken before surgery in the language, the patients understood.

Results: This study includes 8 patients, with median age of 40 years (range 20-70 years). In the study group, 5 were males and 3 were females. The mean operative time was 90 minutes (range 60 t0 120 minutes). There were no major intra operative and post operative complications. The post operative pain was minimal as compared to open surgery. The median hospital stay was 3.5 days (range 3 -6 days). Two patients developed symptoms of bloating, early satiety, nausea and diarrhea. However these symptoms improved within weeks with a good response to appropriate medication. The median time until normal physical activity resumed was 2 weeks (range 3 days to 4 weeks). Median follow-up was 6 months (range1-12 months). The overall short-term results in appropriately selected patients were excellent. The recurrence of symptoms was not observed in any patient within follow up of 6 months.

Conclusion: We conclude from our early series of 8 cases, that patients having long standing GERD not responding to medical management who are at a threat to develop barrettes esophagus should be given the benefit of laparoscopic fundoplication. However proper evaluation, patient selection is mandatory. The choice of fundoplication should be dictated by the surgeon’s preference and experience. Currently, the main indication for laparoscopic fundoplication is represented by PPI-refractory GERD, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained by impedance-pH monitoring.

Laparoscopy, hiatus hernia, reflux, fundoplication

Article Details

How to Cite
Chalkoo, M., Rather, Z., Mohiuddin, F., Bhat, A., Ganie, I., & Arsalan, S. (2019). Laparoscopic Fundoplication for Gastro-esophageal Reflux Disease and Hiatus Hernia: A Short Term Outcome of First 8 Cases. Journal of Advances in Medicine and Medical Research, 30(2), 1-10.
Original Research Article


Kahrilas PJ, Shaheen NJ, Vaezi MF. American gastroenterological association institute technical review on the manage-ment of gastroesophageal reflux disease. Gastroenterology. 2008;135:1392–1413, 1413-1-5. [PubMed] [Google Scholar]

Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010;24:2647–2669. [PubMed] [Google Scholar]

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–328,329. [PubMed] [Google Scholar]

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus. Am J Gastroenterol. 2006;101: 1900–1920,1943.

Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:18-52,13.

Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, et al. British society of gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.

Nissen R. Eineeinfache operation zurbeinflussung der reflux oesophagitis. Schweiz Med Wochenschr 1956;86:590-2.

Nissen R. Gastropexy and fundoplication in surgical treatment of hiatus hernia. Am J Dig Dis. 1961;6:954-61.

DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastro-esophageal reflux disease. Ann Surg. 1986;204:9-20.

DeMeester TR, Stein HJ. Minimizing the side effects of antireflux surgery. World J Surg 1992;16:335-6.

Siewert JR, Feussner H, Walker SJ. Fundoplication: How to do it? Perieso-phageal wrapping as a therapeutic principle in gastro-esophageal reflux prevention. World J Surg. 1991;16:326-44.

Luostarinen MES, Isolauri J, Laitinen J, Koskinen M, Keyrilainen 0, Markkula H, et al. Fate of Nissen fundoplication after twenty years. A clinical, endoscopic and functional analysis. Gut. 1993;34: 1015-20.

Sifrim D, Zerbib F. Diagnosis and management of patients with reflux symptoms refractory to proton pump inhibitors. Gut. 2012;61:1340–1354.

Kahrilas PJ, Howden CW, Hughes N. Response of regurgitation to proton pump inhibitor therapy in clinical trials of gastroesophageal reflux disease. Am J Gastroenterol. 2011;106:1419–1425,1426.

Stein HJ, DeMeester TR. Surgical manage-ment of esophageal disorders. CurrOpinGastroenterol. 1992;8:613-23.

Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic nissen fundoplication: Preliminary report. SurgLaparoscEndosc. 1992;1:138-43.

Geagea T. Laparoscopic Nissen's fundopli-cation: preliminary report on ten cases. Surg Endosc. 1991;5:170-3.

Falk GL, Brancatisano RP, Hollinshead J, Moulton J. Laparoscopic fundoplication: A preliminary report of the technique and post-operative care. Aust NZJ Surg. 1992; 62:969-72.

Warshaw AL. Reflections on laparoscopic surgery. Surgery. 1993;114:629-30.