Original article
New antireflux surgical technique in GERD treatment

Background: Excessive accumulation of air in the stomach with dysphagia is common in patients after Nissen and Toupet antireflux operations. It is caused by habitual air swallowing by nearly all patients with GERD.
Aim: The aim of the study was to present the new technique of antireflux operation based on the anatomy of the properly functioning oesophageal junction.
Materials and methods: 10 patients (7 female and 3 male), aged from 17-76 years (mean 44) were qualified for laparoscopic antireflux operations. The qualification included: a) the presence of typical clinical signs for GERD with the assessment of proton-pump inhibitors treatment efficacy, b) endoscopic and radiological examination of oesophagus and oesophageal junction in order to uncover hiatus hernia. After dissection of the diaphragm crura, they were sutured, and then specially cut mesh was fixed to the diaphragm crura. In the next stage the stomach fundus was sutured to the left side of the abdominal part of the oesophagus. This way an acute His angle was created.
Results: All operations were performed endoscopically. No complications were observed in the perioperative period and there were no reflux recurrences during the 6-month follow-up. In 2/10 patients transient clinical signs resulting from habitual air accumulation in the stomach were noticed.
Conclusions: 1. Presented modification of antireflux operation allows one to create a properly functioning oesophageal junction. 2. The hernia hiatus suture is strengthened by a polypropylene mesh covering. 3. This method protects against the reflux disease and postoperative complications observed in most patients after GERD operations performed so far. Further investigations on late effects of the presented method are needed.