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Collis-Nissen fundoplication using a computer-powered right angle linear cutting stapler in children
Tsubasa Takahashi1, Tadaharu Okazaki, Akihiro Shimotakahara
1Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Insights
Computer-powered right angle linear cutters (CPRALC) offer a safe and effective method for Collis-Nissen fundoplication (CNF) in children with short esophagus. This approach addresses gastroesophageal reflux (GER) and failed Nissen procedures.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Technology
Background:
- Gastroesophageal reflux (GER) and failed Nissen fundoplication in children can be challenging, particularly when associated with a short esophagus.
- Traditional surgical techniques may have limitations in managing these complex cases.
Observation:
- This study reports the clinical experience of using a computer-powered right angle linear cutter (CPRALC) for Collis-Nissen fundoplication (CNF) in three pediatric patients.
- All patients presented with either persistent GER or failed Nissen fundoplication secondary to a short esophagus.
Findings:
- The CPRALC was utilized to perform Collis vertical gastroplasty, effectively elongating the esophagus in all three cases.
- Nissen fundoplication was subsequently performed around the neo-esophagus.
- No intra- or post-operative complications were observed, indicating a safe procedural profile.
Implications:
- This is the first report detailing the use of CPRALC for CNF in pediatric patients.
- The findings suggest that CPRALC is a safe and effective tool for managing GER and failed Nissen fundoplication in children with short esophagus.
- This technique may offer a valuable alternative for complex pediatric anti-reflux surgeries.
Abstract:
We reviewed our clinical experience of using a computer-powered right angle linear cutter (CPRALC) for Collis-Nissen fundoplication (CNF) in three children with gastroesophageal reflux (GER) or failed Nissen associated with short esophagus. Case 1 was a 13-month-old female with persistent GER after type-C esophageal atresia repair. Case 2 was a 2-year-old female with dysphagia secondary to fundic wrap migration after laparoscopic Nissen. Case 3 was a 3-year-old male with post type-C esophageal atresia repair, dysphagia secondary to fundic wrap migration after open Nissen. All had short esophagus confirmed pre- or intra-operatively. After the esophagus was mobilized, Collis vertical gastroplasty was performed using CPRALC parallel to the lesser curve to elongate the esophagus. Nissen fundoplication was performed loosely around the neo-esophagus. There were no intra- or post-operative complications, although case 3 still has mild dysphagia, requiring dilatation. This is the first report of CNF performed using CPRALC in children. It would appear to be safe and effective for treating children with GER or failed Nissen associated with short esophagus.
