Background: Laparoscopic Nissen fundoplication is currently the surgical treatment of choice for gastro-esophageal reflux disease (GERD) in properly selected patients.Methods: Laparoscopic Nissen fundoplication was performed in 36 patients of GERD, Government Medical College over a period of 2 years. Pre-operative evaluation included baseline investigations and clinical assessment by using GERD Questionnaire and specific investigations i.e., barium esophagram, esophago-gastroduodenoscopy, esophageal manometry and 24 hour ambulatory pH monitoring of the esophagus. All patients underwent laparoscopic Nissen Fundoplication. Patients were evaluated at three months after surgery with symptom scoring questionnaire.Results: Mean age of patients in our study was 38 years and most common symptoms were heartburn and regurgitation. Four patients (11%) developed complications. The conversion rate to laparotomy was 2.7% (1 patient). Average symptom scores decreased from 10/18 to 0/18 after fundoplication (<0.0001) and all the eight patients who underwent postoperative endoscopy had normal results.Conclusions: Laparoscopic Nissen’s fundoplication is a safe and effective procedure for GERD, having an acceptable hospital stay with consistently improved short term symptomatic and endoscopic results.

Small bowel obstruction is a common surgical emergency and needs timely intervention to prevent the development of complications. Acute appendicitis is a very rare, uncommon, and unnoticed cause of intestinal obstruction. Although functional obstruction due to paralytic ileus is common in acute appendicitis, mechanical obstruction is a fairly uncommon complication of this extremely prevalent disease. Furthermore, a normal appendix causing full-blown small bowel obstruction due to the tourniquet effect on the terminal ileum is exceptionally rare and the diagnosis is often overlooked. This work report on an extremely rare case of mechanical small bowel obstruction caused by a normal appendix forming tourniquet around an ileum loop. A 40-year-old male patient presented with clinical manifestations of small bowel obstruction, and the appendiceal tourniquet was discovered to be the cause during laparotomy. The patient was subjected to an appendectomy. The histopathological examination of the specimen reported normal appendiceal morphology. The case is unique in that it is the first report of a mechanical small bowel obstruction caused by an appendiceal tourniquet with normal histopathology.