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Unilateral versus bilateral wrap crural fixation in laparoscopic Nissen fundoplication for children
1Department of Pediatric Surgery, Zagazig University, Egypt.
Insights
Bilateral fixation of the fundoplication wrap in neurologically impaired children significantly reduces recurrent GERD after surgery. This method improves outcomes for gastroesophageal reflux disease (GERD) in these patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Background:
- Gastroesophageal reflux disease (GERD) is prevalent in neurologically impaired (NI) children.
- Surgical intervention like fundoplication is considered for NI children with GERD unresponsive to medical management.
- Intrathoracic wrap migration is a common cause of fundoplication failure.
Purpose of the Study:
- To evaluate the impact of fundoplication wrap fixation techniques on laparoscopic Nissen fundoplication outcomes in NI children.
- To compare the efficacy of single-side versus bilateral crus fixation in preventing GERD recurrence.
Main Methods:
- Retrospective analysis of 68 neurologically impaired children undergoing laparoscopic Nissen fundoplication between 2006 and 2013.
- Patients were categorized into two groups: wrap fixation to the right crus (Group 1) and simultaneous fixation to both right and left crura (Group 2).
- Exclusion of patients who had undergone previous redo fundoplication.
Main Results:
- Recurrent GERD at one year was significantly lower in Group 2 (7%) compared to Group 1 (26%).
- The need for redo surgery was substantially reduced in Group 2 (3%) versus Group 1 (21%).
- No increased morbidities were observed with bilateral fixation.
Conclusions:
- Bilateral fixation of the fundoplication wrap to the diaphragmatic crura is an effective method for reducing GERD recurrence in NI children.
- This technique offers improved outcomes without compromising patient safety.
- Further prospective studies with larger cohorts and extended follow-up are recommended.
Introduction:
Gastroesophageal reflux (GERD) is common in neurologically impaired (NI) children. Fundoplication and gastrostomy have previously been indicated in NI children with GERD who have not responded to medical treatment. The most common reason for fundoplication failure is intrathoracic migration of the wrap.
Objective:
The aim of the study is to measure the effect of wrap fixation on the final outcome of laparoscopic Nissen fundoplication in NI children.
Patients And Methods:
A retrospective file review was conducted for all NI children who underwent laparoscopic Nissen fundoplication in 2 tertiary pediatric surgery centers in the United Arab Emirates from February 15, 2006 to February 15, 2013. Redo fundoplication patients were excluded from the study. Patients were divided into 2 groups: group 1 in which the fundoplication wrap was fixed to the right crus only, and group 2 in which the wrap was fixed to the right and left crus simultaneously.
Results:
The study population included 68 patients; there were 47 male and 21 female children. Mean age at time of surgery was 8.2 years. Recurrent GERD at 1 year postoperatively was 26% versus 7% in group 1 and group 2, respectively, by upper contrast study. Redo surgery was required in 21% versus 3% in group 1 and group 2, respectively.
Conclusions:
Bilateral fixation of the wrap to diaphragmatic crura significantly reduced recurrent GERD, in laparoscopic Nissen fundoplication for neurologically impaired children, with no increased risk of morbidities. Future prospective studies should be conducted with larger patient populations and longer follow-up periods.
