Our expert says:
Ek kon een kliniese trial opspoor:
A randomized, controlled clinical trial to assess the long-term symptomatic outcome of a partial posterior fundoplication ( Toupent) as compared to a total fundic wrap ( Nissan) . During the years 1983 to 1991, a total of 137 patients with chronic gastroesophageal reflux disease were enrolled in the study; 72 were randomized to semifundoplication (Toupet) and 65 to total fundoplication (Nissen-Rossetti). A standardized symptom questionnaire was used for follow-up of these patients. A total of 110 patients completed a median follow-up of 11.5 years; 54 had a total wrap and 56 underwent a partial posterior fundoplication. During this period, seven patients required reoperation (Nissen-Rossetti in 5 and Toupet in 2), 11 patients died, and nine patients were lost to follow-up or did not comply with the follow-up program. Control of heartburn (no symptoms or mild, intermittent symptoms) was achieved in 88% and 92% in the total and partial fundoplication groups, respectively, and the corresponding figures for control of acid regurgitation were 90% and 94%. We observed no difference in dysphagia scoring between the two groups, although odynophagia was somewhat more frequently reported in those undergoing a total fundoplication. On the other hand, a significant difference was observed in the prevalence of rectal flatus and postprandial fullness, which were recorded significantly more often in those undergoing a total fundoplication (P < 0.001 and P < 0.03, respectively). Posterior partial fundoplication seems to maintain the same high level of reflux control as total fundoplication. Earlier observations demonstrating the advantages of a partial fundoplication, which included fewer complaints associated with gas-bloat, continue to be valid after more than 10 years of follow-up. Journal of gastrointestinal surgery 2002, vol. 6, no4, pp. 540-545 [6 page(s) (article)]
Die risiko is altyd daar dat die hernia kan herhaal en as mens met die wete in jou agterkop dit laat doen, en as medikasie nie werk nie, "verdien" jy 'n operasie. As jy egter met medikasie die simptome onder beheer kan hou en die breuk is klein, sou ek dalk eerder gewag het tot na die swangerskappe.
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