Evaluation of the mesh-bridged posterior partial fundoplication-a new technique in treatment of gastroesophageal reflux disease

ABSTRACT

Disruption of the wrap and slipping are the most frequent causes of deficient reflux control after anti-reflux surgery. Isolauri et al. [1997], after an experimental study, suggested that if scarring could be induced between the fundal wrap and the esophagus, it could probably help to prevent slippage and disruption of the fundoplication wrap. This study was randomly conducted in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospital on 60 patients suffering from GERD during the period from May 2003 to June 2005. They were randomly classified into two groups; group I comprised 30 patients for whom posterior partial fundoplication [modified Toupet technique] was performed and group II comprised 30 patients for whom mesh-bridged posterior partial fundoplication was performed. At 24 months postoperatively, 4 out of the 30 patients belonged to group I developed recurrence of GERD while none of the 30 patients belonging to group II developed recurrence. The difference in the recurrence rate between the two groups was found to be statistically significant. [P<0.0412]. The mesh-bridged posterior partial fundoplication proved to be effective in achieving the advantages and avoiding the disadvantages of both total and partial fundoplication in short term and mid-term follow-up; good reflux control and low incidence of mechanical complications. Moreover, did not significantly prolong the operation time and did not add to the patients' morbidity