Laparoscopic Nissen Fundoplication ,challenges and outcomes. Prepared by : Dr. Iyad al-Jabri Dr.Mohammed aladini Medical director al-Aqsa hospital. PBGS Head of surgical department. PBGS Master of Oncosurgery

Aim of this study analyze our initial experience. challenges outcomes with laparoscopic Nissen fundoplication that done in al-Aqsa Martyrs hospital.

Success Journey … At January 2016 we start our success journey in performing the first laparoscopic Nissen fundoplication in Al-Aqsa hospital . 24 cases of laparoscopic Nissen fundoplication. 2 cases of laparoscopic Splenectomy. 1 case of laparoscopic small bowel perforation repair. 4 cases of laparoscopic adhesolysis. 10 cases of gynecological procedures.

Epidemiology

Questionnaire

Questionnaire

Questionnaire

Patients and methods 24 adult patients diagnosed with GERD underwent lap. Nissen fundoplication 93 % have typical symptoms of GERD 100% hiatus hernias 100% resistant to medical treatment for GERD obese 33.3 % smokers 20.8 % average age of 32.4 62.5% female 37.5% male From January 2016 to February 2017 From January 2016 to February 2017, consecutive 24 adult patients diagnosed with GERD underwent laparoscopic Nissen fundoplication. There were 37.5% male and 62.5% female, with an average age of 32.4 years, 20.8 % of them were smokers , with 33.3 % of them considered to obese , 93 % have typical symptoms of GERD. All patients were resistant to medical treatment for GERD. Pre-operative endoscopy showed hiatal hernias in 100% of patients.

Age of patients sample

Sex of patients sample

Smoking .

Body mass index

Symptoms associated

Modification of Life style

Medications

Duration of medical treatment

Abdominal U/S findings

Endoscopic Gastroscopy findings

Helicobacter Pylori testing

PH monitoring

Operative finding

Complication associated with procedure

Technique performed during procedure

Evolution in timing!!

Early post operative period :

Recovery

Recovery frequency scale for the symptoms of GERD

Results Laparoscopic approach was successfully done in all patients without conversion. Mean operative time was 114 minutes with minimal mean blood loss. Mean post-operative hospital stay was 4 days. There was 8.3 % intra-operative complication and no mortality.

Litreature review

Conclusion Al-Aqsa hospital despite the modest facilities is considered to be safe for performing laparoscopic Nissen fundoplication for medically uncontrolled GERD and associated hiatus hernia.

Recommendation Supply the hospital with medical equipment in order to increase our productivity. Support the medical staff and facilitate the process of development and scientific work . Work on the sharing of experiences among the different hospitals staff.