Fundoplication with anastomotic wrap : A modification of a Nissen procedure to achieve permanence

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Gastro-oesophageal reflux is a significant concern in children, often managed with gastric fundoplication.
• The Nissen fundoplication is a common surgical approach, but wrap failure is a frequent complication, particularly in neurologically impaired children.
• Suture failure in Nissen procedures can lead to recurrent reflux, necessitating revisions.

Purpose of the Study:

• To introduce and evaluate a modified gastric fundoplication technique designed to improve wrap durability.
• To reduce the incidence of wrap failure and recurrent gastro-oesophageal reflux in pediatric patients.
• To assess the efficacy of a novel surgical modification in neurologically impaired children.

Main Methods:

• A modified Nissen fundoplication was performed, involving the anastomosis of the fundal wrap limbs.
• This technique relies on the stomach wall's natural healing and union for wrap maintenance, avoiding sutures prone to failure.
• The modified procedure was applied to four neurologically impaired children, including three with prior Nissen procedure failures.

Main Results:

• The modified procedure was successfully performed in four neurologically impaired children.
• Three of the four patients had a history of failed Nissen fundoplication.
• One complication, adhesive bowel obstruction, was noted; however, follow-up duration is currently insufficient for definitive outcome assessment.

Conclusions:

• The modified gastric fundoplication, utilizing stomach wall union, presents a potential solution for preventing wrap failure in pediatric reflux surgery.
• This technique may offer improved long-term outcomes for neurologically impaired children prone to wrap dehiscence.
• Further investigation and longer follow-up are required to fully ascertain the efficacy and safety of this surgical modification.