Laparoscopic Nissen Fundoplication with Anterior Versus Posterior Hiatal Repair

Background: Postoperative dysphagia in patients after Nissen fundoplication might be related to the technique used for the closure of the esophageal hiatus.

Methods: A total of 18 patients with gastro esophageal reflux were randomized to undergo laparoscopic Nissen fundoplication with either anterior (9 patients) or posterior (9 patients) repair of the diaphragmatic hiatus. Outcomes were assessed for dysphagia, reflux and satisfactory outcome following surgery.

Results: Clinical outcomes 18 months after surgery were available for 100% of patients. There was no significant difference between the 2 techniques for symptoms of dysphagia all through the short term follow-up evaluation. Better control of heartburn was achieved in patients in the anterior hiatal repair group. Patients from both groups were equally satisfied with the overall outcome after surgery.

Conclusion: Within the 18 months follow-up evaluation, there was no significant difference in dysphagia between anterior and posterior hiatal repair. However, long term follow up studies should be done to confirm this outcome.

Author(s):

Nader.sh.zaki, Wael.M.Tobar, Hani Armia,Mohamed Fahmy, Nayer Nabil

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