Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernia with severe gastroesophageal reflux disease. A retrospective cohort study

Background: Laparoscopic Nissen Fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (> 5 cm) with severe GERD (DeMeester score >100). Materials and methods: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. Results: 360 patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9% vs. 8.3%) and recurrent regurgitation (2.2% vs. 5%) showed a lower incidence in the LNF+ group (P=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0% vs. 3.3% and 0% vs. 2.8% cases in the LNF+ and LNF groups, respectively (P=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75% vs. 5.6% and 0% vs. 3.9% of patients (P=0.001). Score III postoperative persistent dysphagia was 0% vs. 2.8% in the two groups (P=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3% vs. 86.7% in both cohorts, respectively (P=0.05). Conclusions: Intraoperative high-resolution manometry (HRM) and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint

Skin Sparing Fistulectomy with Primary Sphincters Repair by Special Sutures for Management of High Perianal Fistula

Background: Fistula in ano is a common disease seen in the surgical outpatient department. Many procedures are advocated for the treatment of fistula in ano. However, none of the procedures is considered the gold standard. Aim of this study was to evaluate our procedure in the managing high perianal fistula.Methods: Between February 2014 and September 2015, 71 patients with high perianal fistula were managed by skin sparing fistulectomy and special sutures for primary repair of anal sphincters. The clinical outcome was assessed in terms of time for healing, continence and recurrence for followup period (ranged from 4 to 24 months).Results: Anorectal wounds were healed within 3 to 4 weeks. Complications included urine retention 9 patients (12.7 %), superficial wound infection 29 patients (40.9 %), and transient incontinence 33 patients (46.5 %) for flatus for period ranged from 2 to 3 weeks. No deep infection, no permanent incontinence were recorded. Recurrence was in one patient (1.4 %).Conclusion: Our technique is less invasive, rapid healing, maintain on normal configuration of anus, and associated with good results for high perianal fistula management.</p