Dysphagia After Anti-Reflux Surgery; a comparative study between laparoscopic Nissen fundoplication and its Rossetti’s modification

Abstract

Gastroesophageal reflux disease is increasingly prevalent and costly, and it may affect as much as 20% of the western population. The aspect of the standard Nissen fundoplication –dividing the short gastric vessels- can be quite challenging, although the introduction of the laparoscopic coagulating shears, or harmonic scalpel, has facilitated this process. Some surgeons argue that division of the short gastric vessels is not needed to create a loose fundoplication, others claim that not doing so can lead to a more restrictive wrap and thus increased postoperative dysphagia The laparoscopic Nissen’s fundoplication procedure provided an excellent solution for this problem and has been standing against time since the development of this procedure. A wide range of modifications were offered to improve the efficacy and decrease the morbidity of this operation, one of them was the Rossetti-Hell modification; a highly debatable approach once put in comparison with the original procedure. In our study, an objective comparison was made between the two procedures focusing on multiple aspects of both procedures to stand on the superiority of each one over the other. We compared data including: subjective results of symptomatic relief (DeMeester’s score), quality of life (HR-