Related Experiment Videos
Paraesophageal hernia after Nissen fundoplication: a real complication in pediatric patients
A Alrabeeah1, M Giacomantonio, D A Gillis
1Department of Surgery, IWK Hospital for Children, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Paraesophageal hernia (PEH) can occur after Nissen fundoplication in children. Infants under one year and those without crural repair face higher PEH risks, necessitating extended follow-up and technical adjustments.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Complications
Background:
- Nissen fundoplication is a common surgical procedure for gastroesophageal reflux disease in children.
- Paraesophageal hernia (PEH) is a potential complication following anti-reflux surgery.
- Understanding risk factors and optimal follow-up is crucial for pediatric surgical outcomes.
Purpose of the Study:
- To investigate the incidence and timing of paraesophageal hernia (PEH) after Nissen fundoplication in pediatric patients.
- To identify patient-specific and surgical factors associated with PEH development.
- To recommend optimal follow-up protocols and potential technical modifications.
Main Methods:
- Retrospective review of 89 pediatric patients undergoing Nissen fundoplication.
- Analysis of follow-up data, including upper gastrointestinal (GI) series, for 55 patients.
- Stratification of patients into groups based on neurological status, prior tracheoesophageal fistula, and age at surgery.
Main Results:
- Fifteen patients (16.8%) developed PEH, diagnosed between 4 and 36 months post-fundoplication.
- Higher PEH incidence was observed in patients with significant mental dysfunction (20%) and those under one year of age (20%).
- Crural repair during fundoplication was associated with a significantly lower PEH rate (4%) compared to no crural repair (21.9%).
Conclusions:
- Extended follow-up (up to 36 months) with upper GI series is recommended after pediatric Nissen fundoplication.
- Infants under one year of age may represent a higher-risk group for PEH development.
- Incorporating crural repair into the surgical technique may help prevent PEH after Nissen fundoplication.
Abstract:
Eighty-nine pediatric patients aged 6 weeks to 20 years (mean, 3.8 years) who underwent Nissen fundoplication were reviewed. Follow-up, including upper gastrointestinal (GI) series, was obtained in 55 patients (61.8%). Fifteen patients developed paraesophageal hernia (PEH) (16.8%). PEH was diagnosed between 4 and 36 months following fundoplication (mean, 17 months). Patients were divided into three groups: A, those with significant mental dysfunction (45); B, those with previous tracheoesophageal fistula (12); and C, others (32). Incidence of PEH is 20% for group A, 16.8% group B, and 12.5% group C. Combining groups B and C, 5 of 25 patients (20%) who underwent fundoplication at less than 1 year of age developed PEH, whereas one of 19 older patients (5.3%) developed PEH. One of 25 patients (4%) who had crural repair at fundoplication developed PEH, whereas 14 of 64 patients without crural repair (21.9%) developed PEH. At surgery, PEH occurred at the left posterolateral aspect of esophagus. We conclude that (1) follow-up after fundoplication should continue for 36 months and include upper GI series; (2) patients under one year of age undergoing fundoplication may be at a higher risk for PEH; and (3) technical refinement including crural repair may be required to prevent PEH.