Laparoscopic antireflux surgery - our initial experience

Abstract

Introduction: Laparoscopic antireflux surgery (LARS) currently represents the gold standard in the surgical management of gastrointestinal reflux disease (GERD) with minimal morbidity and mortality. Routine fundoplication following laparoscopic Heller’s cardiomyotomy is also being recommended to reduce the incidence of pathological gastro-oesophageal reflux after surgery. The aim of the current study was to evaluate patients receiving LARS and to assess their surgical outcomesMethods: Prospective data of all patients admitted in our department with these diseases and undergoing LARS, from May 2014 to November 2015 were reviewed. Patients with Achalasia cardia underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication and those with GERD with hiatus hernia underwent Laparoscopic Toupet’s fundoplication. Age, sex, duration of surgery, surgical morbidity and hospital stay were recorded. Results: Eleven patients underwent LARS. Females were 5(45.5%) and males were 6 (54.5%). Mean age of patients was 36.18 ± 15.79 years (range 18-68 years). 6 patients (54.5%) underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication for Achalasia cardia while 5 patients (45.5%) underwent Laparoscopic fundoplication. The median operating room time was 133.64 ± 15.66 minutes (range, 110–160). There were no conversions. The median hospital stay was 3.45±0.522 days (range, 3-4 days). No postoperative complications or preoperative deaths occurred. No patient had a perforation revealed on the postoperative contrast swallow when performed. Gastro esophageal reflux symptoms were significantly improved and severity of dysphagia was also reduced after surgery. The average follow-up period is 5.45 ± 2.67 months (range, 3- 12).Conclusion: LARS is well established technique and becoming more popular over conventional open surgery in view of its equal safety and efficacy with added advantage of less morbidity and mortality. However larger case series and long term follow up would be warranted.

Comparative Analysis of Data Protection Laws Among the SAARC Countries: An Appraisal

“…Nepal:The following are the existing laws in Nepal that regulate the issues regarding privacy: Constitution of Nepal [39]; Individual Privacy Act, 2018; The Civil Code, 2017; The Criminal Code, 2017 [40]; The Labour Regulations, 2017. The Government of Nepal (hereinafter "GON") has recently drafted a bill relating to information technology and placed the same before the Parliament for discussion [41]. The provisions of the proposed bill, however, are subject to modification before its enforcement as an enactment [41].…”

“…The Government of Nepal (hereinafter "GON") has recently drafted a bill relating to information technology and placed the same before the Parliament for discussion [41]. The provisions of the proposed bill, however, are subject to modification before its enforcement as an enactment [41]. Moreover, the govt.…”

“…is yet to enact a regulation corresponding to the Act. [42], the Supreme Court ruled that the right to privacy as guaranteed by the Constitution must be protected and an exception to this well-established general rule, i.e., information sharing with third parties, can only be made where prior consent has been obtained from the person concerned [41]. In Baburam Aryal v. GON [43], the Supreme Court held that the right to privacy, being a fundamental right, is guaranteed by the Constitution and should not be violated by the State or by any third party.…”

“…The Supreme Court further added that under the ambit of the right to privacy, things relating to a person"s body, communications, character, documentation, data, residence and property are inviolable except as otherwise permitted by any law. An entity (that may be either a natural or legal person) that collects and assembles information, has undertaken an obligation for such information and such information shall not be used whimsically at its discretion [41]. Instead, such an entity or department must shield such a "data bank" of information by hook or by crook.…”

“…Instead, such an entity or department must shield such a "data bank" of information by hook or by crook. The Supreme Court also laid down that the entity must not allow unwarranted and unauthorized access to such a "data bank", even as a special case in the absence of a lucid legal basis [41].…”