Discussion
dysphagia, Floppy, Su, gastrointestinal symptoms, bloating, esophageal irritation, reflux, postoperative dysphagia, GERD, heartburn, diarrhea, hernia, vomiting, Bloating, inability to belch,, belch, vagal injury
DYSPHAGIA, RECURRENCE, REFLUX, GERD, GASTROESOPHAGEAL REFLUX DISEASE
The development and prevalence of laparoscopic anti-reflux surgery have led to a decline in morbidity, mortality and even surgical treatment recurrence rates [There are two major anti-reflux procedures: 360° total (Nissen) fundoplication and 270° partial (Toupet) fundoplication The Rossetti modification to the Nissen fundoplication built on Nissen’s original approach, involving the fixture of the anterior surface of the fundus to the anterior surface of the fundus by wrapping it around the esophagus after the complete mobilization of the abdominal esophagus and lesser curvature. Su et al. In their study in which they compared the efficacy and safety of laparoscopic Nissen, Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease, these three laparoscopic fundoplications were found to be safe and feasible in the treatment of hiatal hernia complicated with GERD. However, laparoscopic Nissen and Dor fundoplication showed that it was better than Toupet fundoplication in reducing the number of reflux episodes, suppressing long reflux, increasing lower esophageal sphincter pressure, and reducing the incidence of postoperative dysphagia [Randomized controlled studies have shown the Rossetti modification to be at least as successful as the classical Nissen fundoplication [Clinical observations have shown that new gastrointestinal symptoms can occur and existing symptoms can continue in the postoperative period. Negre identified bothersome and unbearable gastrointestinal symptoms in 26% and 10%, respectively, of the patients in their study, while Swanstrom reported a rate of 96% [Bloating and dysphagia are the most common postoperative symptoms discussed in the literature [Very different rates of dysphagia have been reported in the literature, with Beldi and Glattti reporting a dysphagia rate of 25% and Frantzides et al. a rate of 34% [The mechanism of an inability to belch, as another common symptom after anti-reflux surgery, can be explained as follows: The reflex required to belch begins with the stimulation of tension receptors in the fundus. The dissection of short gastric vessels during the operation may lead to the dissection of the afferent nerves required for this reflex, resulting in the loss of reflex, leading potentially to an inability to belch in the postoperative period. A previous study found the rate of inability to belch to be 22%, while our study established a rate of 20%, which is consistent.Regurgitation and heartburn are the two main symptoms of GERD. It should not be assumed that patients who express ongoing heartburn are experiencing a recurrence of reflux, as continuing symptoms may be attributable to the previous esophageal irritation, and it may take several months for this to fully resolve. Many studies have reported that these symptoms largely resolve within three months [In the present study, the rate of taking medication due to newly developed symptoms in the postoperative period was 8.8%, while a rate of 14% was reported in a study comparing postoperative 5–8 year outcomes [Despite all of these postoperative symptoms, 92.5% of the patients were satisfied with their current condition, and 92.5% responded ‘yes’ when asked ‘If you developed reflux again, would you have this surgery?’ Only 7.5% of the patients had recurrent symptoms and 8.8% were undergoing irregular medical treatment.Laparoscopic fundoplication procedures have proven to be successful for the treatment of gastroesophageal reflux disease with low morbidity. As can be seen, gastrointestinal symptoms occur at various rates after laparoscopic surgery, and multiple theories have been put forward to explain the mechanisms behind their occurrence. There are different mechanisms behind the development of different symptoms, including vagal injury, tight fundoplication, the shift of the fundoplication into the thorax, dietary habits and air swallowing [The high patient satisfaction rate, even in the presence of gastrointestinal symptoms, is proof that the operation is effective and well-tolerated. The main determinant here, however, is the frequency and severity of symptoms. One of the factors determining satisfaction with the operation relates to patient expectations from the operation. Obviously, if patients are told that they may experience such postoperative symptoms as bloating, inability to belch, vomiting and sometimes diarrhea, and that these symptoms may occur depending on the physiology of the surgery, patient satisfaction will be increased.The limitations of our study were that the data were obtained based on verbal statements and that some of the data were relatively subjective.Our study concluded that the surgical treatment option can be chosen for the treatment of GERD, and that the Nissen–Rossetti technique can be used safely based on the similarity of its outcomes with those of the classical Floppy–Nissen technique, but with a shorter operation duration.