Laparoscopic Nissen Fundoplication becoming Popular in India
Incidence of Gastro Esophageal reflux disease (GERD) is increasing day by day. If we will compare with 1980 the incidence of GERD is Laparoscopic Nissen fundoplication is now considered the standard surgical approach for treatment of severe gastroesophageal reflux disease (GERD) all over World. GERD is increasingly prevalent and medical management of this disease in long term costly, and its effects are experienced daily by up to 10% of the population. It is important to understand that pathophysiology of GERD is not only due to acid overproduction but rather in majority of cases mechanical dysfunction centered on the lower esophageal sphincter.
The mainstay of GERD treatment used globally is, proton pump inhibitors or H2 receptor antagonist. The medicine have come under scrutiny due to worrisome side effects. More recently, laparoscopic magnetic sphincter augmentation of the lower esophageal sphincter called Linx augmentation system has been proposed as an additional surgical option for mild cases. Like the Nissen fundoplication, it relies enforcing buttressing of the lower esophageal sphincter, but with the potential for fewer long-term adverse effects.
History of Laparoscopic fundoplication is very interesting. Dr. Rudolf Nissen (1896-1981) described the first fundoplication in the 1950s for treatment of severe reflux esophagitis. His original procedure of Nissen Fundoplication used a 360 degree wrap of the fundus of the stomach around the esophagus and creating suturing by plication of both the anterior and posterior walls of the gastric fundus around the lesser curvature. With increasing time the standard Nissen fundoplication has been modified all over World by different surgeon many times, laparoscopic Nissen fundoplication is now considered the standard surgical approach for treatment of GERD.
If we we will compare GERD laparoscopic antireflux surgery with medical treatment by proton pump inhibitor, there has been considerable debate. A systematic review concluded similar efficacy between these medical and surgical treatment options. Some recent literature suggests that long-term outcomes from laparoscopic fundoplication surgery may be superior to medical treatment. Laparoscopic fundoplication surgery may be more cost effective than lifelong medical treatment.
The latest guidelines from the World Association of Laparoscopic Surgeons indicate, Laparoscopic Fundoplication is as effective as medical therapy for carefully selected patients with chronic GERD when performed by an experienced minimal access surgeon in selected patients. If we will compare with open surgery the long-term outcomes relative to subjective symptoms from laparoscopic Nissen fundoplication are comparable to open results.
|Older Post||Home||Newer Post|