Laparoscopic left-sided Nissen fundoplication in children

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Standard laparoscopic techniques for adult Nissen fundoplication present challenges in pediatric patients.
• Smaller anatomical structures and limited working space in children complicate procedures like crural dissection and retroesophageal window creation.

Purpose of the Study:

• To describe a modified laparoscopic technique for Nissen fundoplication specifically adapted for pediatric patients.
• To address the difficulties encountered in dissecting and repairing the diaphragmatic crura in pediatric laparoscopy.

Main Methods:

• A novel left-sided surgical approach for crural dissection and repair was developed.
• The port configuration for laparoscopic instruments and the laparoscope was altered to enhance visualization and maneuverability.

Main Results:

• The modified technique provides improved surgical exposure.
• Easier instrument handling was achieved, even in very small pediatric patients.
• Successful dissection and repair of the diaphragmatic crura were facilitated.

Conclusions:

• This left-sided approach offers a viable solution for challenging steps in pediatric laparoscopic Nissen fundoplication.
• The technique enhances safety and efficacy in pediatric minimally invasive gastrointestinal surgery.