Purpose: Nissen fundoplication is still assumed as the perfect lifelong management for gastroesophageal reflux disease (GERD). Despite the marked progress in performing the operation laparoscopically, dysphagia remains the most common postoperative morbidity. The use of an intraesophageal bougie during fundoplication to decrease the risk of postoperative persistent dysphagia (PD) by a forming proper tension-free wrap has been reported before in the literature. However, the aim of our study was to highlight the role of using a bougie in allowing a more guided way to repair the crura and avoiding blinded posterior repair, and the effect of that in reducing the incidence of postoperative PD in laparoscopic Nissen fundoplication.
Materials and methods: A prospective study including 40 patients undergoing laparoscopic Nissen fundoplication for repairing hiatal hernia with refractory GERD. The crural repair was guided by 50 Fr bougie. Postoperative collection of GERD–health-related quality of life (GERD–HRQL) questionnaire was done at 1 and 6 months for all the patients. The postoperative dysphagia was assessed regarding both severity and frequency.
Results: The GERD symptoms significantly improved in all patients, with marked postoperative satisfaction. No patients required dilation for postoperative dysphagia. Ten patients (25%) had mild dysphagia that resolved with conservative management, but no recurrence of GERD symptoms was observed.
Conclusion: Laparoscopic Nissen fundoplication is more efficient on using a bougie, allowing proper identification of the direction of esophageal descent through the hiatus, resulting in proper crural repair and the formation of an ideal wrap with a low-risk of prolonged dysphagia.
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