Intraoperative Endomanometric Laparoscopic Nissen Fundoplication Improves Postoperative Outcomes

Inclusion Criteria: * patients 18≥ years with large sliding hiatus hernia (\> 5 cm) with severe GERD patients (DeMeester score \>100)with typical symptoms and successful medical management (due to quality of life considerations, life-long need medication intake or cost) or patients with unresponsive or inadequate symptom control despite eight weeks of adequate medical therapy with or without extra-esophageal Atypical symptoms that are related to GERD(cough, Globus, or hoarseness) confirmed diagnosis by hypotensive lower esophageal sphincter confirmed by HRM and a positive pH/impedance test (based on DeMeester scores) * fitness and consenting for surgery * patients that completed three year follow up period, * with esophagitis Exclusion Criteria: * \<18years, * pregnancy, * Patients unfit for surgery \[ comorbid condition like severe cardiac illness, chronic respiratory diseases, chronic renal failure, and bleeding disorder\], * Non cooperative or lost patients for regular follow up, * Patients who had undergone previous antireflux surgery or who required a concurrent abdominal procedure at the same time as fundoplication (eg, cholecystectomy), - * psychiatric disorders. * esophageal dysmotility,