Patients/materials and methods
Floppy, dysphagia, bloating, diarrhea, reflux, gastroesophageal reflux, heartburn, abdominal pain, hernia, vomiting, inability to belch, NERD, esophagitis, hernias, esophageal motility disorders
DYSPHAGIA, SWALLOWING DIFFICULTIES, REFLUX, GASTROESOPHAGEAL REFLUX, ESOPHAGEAL MOTILITY DISORDERS, POSTOPERATIVE COMPLICATIONS, REFLUX, DIFFICULTY SWALLOWING, ESOPHAGITIS, GASTROESOPHAGEAL REFLUX DISEASE, DISEASE
After approval for the study was granted by the Ethics Committee of the Çukurova University Faculty of Medicine, 126 patients who presented to the General Surgery Department outpatient clinic of Balcalı Hospital of the Cukurova University Faculty of Medicine, with gastroesophageal reflux between March 2010 and March 2013 were evaluated. Excluded from the study were 16 patients with Nonerosive Reflux Disease (NERD), detected by endoscopy, and with reflux proven by a pH meter; 24 patients with endoscopic esophagitis, but with no hiatal hernia; and six patients with esophageal motility disorders detected by the manometer. The 80 study patients that remained, all of whom had endoscopic hiatal hernias and various degrees of esophagitis, were operated on sequentially using one of two procedures – a laparoscopic Floppy–Nissen procedure (group 1) or a laparoscopic Nissen–Rossetti procedure (Group 2) – for which the selection was made using a simple randomization method Randomization was done sequentially, regardless of the patients’ age, gender, education level, duration of preoperative symptoms and preoperative esophagitis degree. Floppy Nissen was applied to one patient and Rosetti Nissen to the other patient, in sequential order. Data collection and analysis were done in a blinded manner. All procedures were performed by the same surgeon (Cem Kaan Parsak MD).At the outset of the study, the patients’ age, sex, educational level, endoscopic esophagitis grade, duration of preoperative symptoms, duration of preoperative medical treatment, year of surgery, duration of surgery, duration of postoperative follow-up, presence/absence of postoperative complications, and presence of reoperation were all recorded.Endoscopic assessment of esophagitis were performed in accordance with the Los Angeles classification [In the postoperative follow-up period, the patients were administered a satisfaction questionnaire inquiring about the presence of dysphagia, and if so, what kind of food was difficult to swallow. The evaluation was made on a scale of 0–4 (0 = no swallowing difficulties, 1 = difficulty swallowing solid food, 2 = difficulty swallowing soft food, 3 = difficulty swallowing liquids, and 4 = difficulty swallowing all).The patients were then administered a further questionnaire to determine the levels of heartburn, bloating, frequent belching, diarrhea, abdominal pain, vomiting and inability to belch, with evaluations, again made on a scale of 0–4 (0 = no symptom, 1 = mild [noticeable but not bothersome every day], 2 = moderate [noticeable and bothersome every day], 3 = often [affecting daily life], and 4 = very often [limiting daily life]).The patients were also administered a preoperative gastroesophageal reflux disease – health-related quality of life (GERD-HRQL) questionnaire (Written informed consent was obtained from all participants and all study procedures were conducted according to the Declaration of Helsinki.Statistical analyses were performed using SPSS for Windows (Version 16.0. Chicago, SPSS Inc.), and included a Wilcoxon test, a Kruskal–Wallis analysis of variance, Spearman’s correlation coefficient and a Mann–Whitney 