Nissen’s fundoplication was not preferred due to the greater incidence of postoperative dysphagia [3]. Also, most patients were poor and hailed from the rural interiors and would not be able to follow up regularly and afford repeated dilatations if required. Transient postoperative dysphagia was the commonest selleck inhibitor complication, seen in 46.66% of the cases. However, it was only temporary and subsided within 6 weeks in all cases without any treatment, except for reassurance and adjustment of food habits. The rare complications of pleural breach, splenic injury, and esophageal perforation occurred in 1 case each and these 3 cases required conversion to open surgery. These complications occurred in the initial period of the study, demonstrating that there is a learning curve in laparoscopic surgery.

Wound infection was seen in 30% of the cases; however, it was always a minor infection requiring removal of a single skin suture. None of the patients with wound infection developed fever or required incision and drainage or increase in duration of hospital stay. No patient developed a major infection that persisted for 10 or more days. This is in accordance with the study of 10 patients by Parshad et al. [8], where one patient (10%) required reexploration due to bleeding from a short gastric vessel. The most frequent postoperative complication was temporary dysphagia in 60% of patients, which improved with conservative management over 2 to 3 weeks [8]. After 3 months of medical management, mean score of heartburn showed statistically significant rise of 1.17 times (117%) in 20 patients.

These patients were continued on conservative management while the other 30 were operated. At 9 months, mean score of heartburn showed significant increase of 1.50 times (150%) among the operative group and 1.30 times (130%) in the conservative group from baseline. After 3 months of medical management, mean score of regurgitation showed statistically significant increase of 1.07 times (107%) in 20 patients. Thus these patients were continued on conservative management while the other 30 patients were operated. At 9 months, mean score of regurgitation showed significant increase of 1.08 times (108%) among the operative group and 1.11 times (111%) in the conservative group from baseline. These findings were similar to those obtained in the review of four trials by Wileman et al.

[9]. On endoscopy, 100.0% cases had hiatal hernia at baseline. At 3 months after surgery, 96.66% cases did not have hiatal hernia as compared to baseline. This difference was statistically significant. Overall, though 22 patients (73.33%) had esophagitis before surgery, only 1 patient had persistent esophagitis after surgery. Thus 70% patients showed improvement in esophagitisafter GSK-3 surgery. These findings are similar to those obtained by Parshad et al. [8], where 8 out of 9 patients (88%) had endoscopic resolution of esophagitis [8].