Long-term outcome of laparoscopic Nissen-Rossetti fundoplication versus Thal fundoplication in children with esophageal hiatal hernia: a retrospective report from two children's medical centers in Shanghai

Eversion cruroplasty and collar overwrap: a novel hybrid approach for refractory gastroesophageal reflux disease in children, with assessment of mid-term outcomes

BACKGROUND

Surgical fundoplication remains integral in managing gastroesophageal reflux disease (GERD) by addressing gastroesophageal valve incompetence. This study introduces a novel hybrid approach, the Eversion Cruroplasty and Collar Overwrap (ECCO) procedure, aiming to combine benefits of conventional partial wrapping and posteromedial cardiopexy, considering gastric fundus anatomical peculiarities as an anti-reflux barrier.

METHODS

A retrospective analysis of pediatric patients presenting with refractory GERD from 2021 to 2023 was conducted. Inclusion criteria focused on primary GERD cases; secondary and redo cases were excluded. Diagnostic modalities included upper gastrointestinal contrast series and endoscopy. Demographic, operative, and postoperative data were assessed.

RESULTS

Among 57 cases, 8 with recurrent hiatal hernia were excluded. Enrolled cases (n = 49) had a mean age of 3.78 years and mean weight of 11.9 kg. All underwent laparoscopic ECCO procedure, with a mean operative time of 87 min. During follow-up, six children experienced transient gas-bloat, and four had temporary dysphagia to solids. Two cases required revisions for absolute failures, while three managed partial recurrences with proton pump inhibitors. Of the total 49 cases, only nine required postoperative endoscopic assessment, which revealed a fully competent cardia with adequate wrapping in four of them. The remaining 40 cases demonstrated clinical improvement with the cessation of PPIs over a mean follow-up period of 11.6 months.

CONCLUSIONS

'Eversion Cruroplasty' preserves crural pillar muscle excursion, avoiding segmentation seen with traditional suturing. The 'Collar Overwrap' achieves a 90% success rate, aligning the GE-junction while maintaining fundic pouch geometry, emphasizing its effectiveness and anatomical fidelity.

Preferential performance of Thal fundoplication for gastroesophageal reflux disease: a single institution experience

PURPOSE

Nissen fundoplication (NF) is the most commonly used surgical treatment for persistent gastroesophageal reflux disease (GERD). We introduced to the alternative Thal fundoplication (TF) (partial anterior wrapping) in 1998. The purpose of this paper is to review and report on the effectiveness of TF in our department.

METHODS

We retrospectively analyzed cases of 281 patients who underwent TF for GERD at our hospital from 1998 to 2019.

RESULTS

Average age, 16.3 ± 18.1 years; average body weight, 21.0 ± 16.0 kg; average operative time, 89.1 ± 43.0 min; average volume of bleeding, 11.6 ± 29.2 g; enteral feeding commenced after an average of 3.4 ± 1.3 postoperative days (PODs), and average postoperative full enteral feeding was 6.3 ± 1.4 PODs. Five patients (1.8%) had Clavien-Dindo classification III or higher; average hospital stay duration was 10.3 ± 6.0 days, with symptom recurrence affecting 17 patients (6.1%).

CONCLUSION

TF may be an effective and simple treatment for GERD that has few recurrences and avoids complications common to NF, but further studies to compare it with other techniques are needed.

Development of pediatric minimally invasive surgery in mainland China

Pediatric laparoscopic surgery has developed rapidly in the past 20 years in mainland China with the help of international collaborative training programs. High-volume laparoscopic workload has enabled Chinese pediatric surgeons to innovate and gain experience within a short span of time. We feel that outcomes are comparable or even in some cases superior to that of open surgery. In this article, based on the Storz Lecture to the 65th BAPS Congress in Liverpool, we share our experience of this rapid development of pediatric laparoscopy. EVIDENCE LEVEL: V.

Congenital hiatus hernia: A case series

OBJECTIVE:

Hiatus hernia is frequent in adults and rare in children; congenital hiatus hernia is even rarer. In this study, we describe a group of infants with congenital hiatus hernia and discuss its management.

METHODS:

Records of patients (male: 3, female: 4) who were diagnosed with congenital hiatus hernia between 2010 and 2016 were extracted. Demographic data, presenting symptoms, diagnostic investigations, operative details, postoperative follow-up, and early and late postoperative complications were evaluated retrospectively.

RESULTS:

Four patients were female and three were male. One patient was diagnosed prenatally while the mean age at diagnosis for others was 18.6 months. Four patients had type IV hernia, 2 had type III hernia, and one had type I hernia. The diagnosis was confirmed by chest X-ray, computerized tomography (CT) and/or upper gastrointestinal series. The hiatal repair was done in all patients either by laparotomy or laparoscopy. During the procedure, 2 patients had Nissen fundoplication and 3 patients had Thal fundoplication. Recurrence of hernia occurred in the 2 patients who had Thal fundoplication.

CONCLUSION:

Recurrence of sliding hernias with Thal fundoplication seem more frequent in the series. If the esophagogastric junction is present in the thorax, mediastinal dissection of the esophagus may be required to achieve a good abdominal esophagus structure, which will prevent a recurrence.