1. 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

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

3. 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.

4. Epidemiology

5. Questionnaire

6. Questionnaire

7. Questionnaire

8. 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.

9. Age of patients sample

10. Sex of patients sample

11. Smoking .

12. Body mass index

13. Symptoms associated

14. Modification of Life style

15. Medications

16. Duration of medical treatment

17. Abdominal U/S findings

18. Endoscopic Gastroscopy findings

19. Helicobacter Pylori testing

20. PH monitoring

21. Operative finding

22. Complication associated with procedure

23. Technique performed during procedure

24. Evolution in timing!!

25. Early post operative period :

26. Recovery

27. Recovery
frequency scale for the symptoms of GERD

29. 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.

30. Litreature review

33. 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.

34. 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.