Abstract

Background: Hiatal hernia often leads to gastroesophageal reflux disease (GERD), which may be refractory to medical therapy. Surgical intervention in the form of Nissens fundoplication can provide definitive relief. With advancements in minimally invasive techniques, the role of laparoscopic Nissens fundoplication is increasingly prominent. Aim: To compare the effectiveness of open versus laparoscopic Nissens fundoplication in patients with endoscopically confirmed hiatal hernia. Objectives: • Compare operative time, symptom relief, and complications in open and laparoscopic procedures. • Evaluate improvement using De-Meester Johnson reflux score. Material: A prospective study involving 38 patients (18-60 years) at a tertiary care hospital over 18 months (Sep 2022 - Mar 2024). Patients were randomized into two equal groups for open or laparoscopic Nissens fundoplication. Results: Both groups showed significant symptomatic improvement. Laparoscopic surgery had a longer operative time (135 vs 110 minutes) but fewer complications and better De-Meester scores Post-operatively. Statistically significant improvement in heartburn, regurgitation, and dysphagia was observed, especially by Postoperative day 7. Conclusion: Laparoscopic Nissens fundoplication is as effective as open surgery in relieving GERD symptoms, with additional benefits of fewer complications and faster recovery, despite longer operative duration.

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