Mesh hiatal reinforcement in Nissen fundoplication

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Nissen fundoplication is a common surgery for gastro-oesophageal reflux (GOR).
• Recurrent or persistent GOR post-fundoplication occurs in up to 20% of cases.
• Neurologically impaired children are at higher risk for persistent GOR.

Purpose of the Study:

• To highlight the incidence and risk factors for persistent GOR after Nissen fundoplication.
• To propose mesh hiatal reinforcement as a solution for specific patient groups.
• To advocate for mesh reinforcement in reoperative cases or when diaphragmatic crura require support.

Main Methods:

• Review of surgical outcomes for Nissen fundoplication.
• Analysis of patient populations experiencing recurrent GOR.
• Evaluation of the utility of mesh hiatal reinforcement.

Main Results:

• Persistent or recurrent GOR is observed in up to 1 in 5 patients post-Nissen fundoplication.
• Neurological impairment is a significant risk factor for persistent GOR.
• Mesh hiatal reinforcement is presented as a viable technique for managing complex cases.

Conclusions:

• Mesh hiatal reinforcement offers a valuable approach for managing persistent GOR in reoperative settings.
• Reinforcement of the diaphragmatic crura with mesh may prevent GOR recurrence.
• This technique is particularly beneficial for neurologically impaired children requiring fundoplication.