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Updated: Oct 30, 2025
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Published on: August 11, 2023
Minimal esophagus dissection without approximating the hiatus in laparoscopic fundoplication in pediatric population
Ergun Ergun1, Gulnur Gollu1, Ufuk Ates1
1Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
Insights
Minimal esophagus dissection during laparoscopic Nissen
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic Nissen's fundoplication (LNF) requires adequate esophageal and hiatus dissection for a proper wrap.
- Excessive dissection can increase patient morbidity.
Purpose of the Study:
- To evaluate the impact of minimal esophageal dissection in LNF on recurrence and post-operative hiatal hernia rates in children.
Main Methods:
- Retrospective analysis of 143 children (0-18 years) who underwent LNF with minimal esophageal dissection and no hiatal closure (2008-2016).
- Evaluation focused on recurrence and post-operative hiatal hernia development.
Main Results:
- 143 children included; 54% had neurological impairments.
- Low complication rate: 2 temporary obstructions, 1 esophageal tightness requiring dilatation.
- One case of recurrence with hiatal hernia necessitated reoperation.
Conclusions:
- Minimal esophageal dissection in LNF, without hiatal closure, effectively prevents dysphagia.
- This approach does not increase recurrence or complication rates.
Objective:
An important part of laparoscopic Nissen's fundoplication (LNF) is a proper wrap, which may only be possible with proper dissection of esophagus and hiatus. However, too much dissection of esophagus and hiatus to gain sufficient length of esophagus increases morbidity. The aim of this study is to analyze the effect of minimal esophagus dissection in LNF on recurrence and post-operative hiatal hernia.
Methods:
The present study includes the children (0-18 years) who underwent LNF with minimal esophagus dissection and without hiatal closure between 2008 and 2016. The charts of the patients analyzed retrospectively and evaluated in terms of recurrence and post-operative hiatal hernia.
Results:
There were 143 children. Mean age was 4.5±4.6 year (20 days-17 years). About 54% of the children (n=78) were neurologically impaired. There were two temporary intestinal obstructions which did not require surgery, one esophageal tightness which resolved with one dilatation session and one recurrence with hiatal hernia which required reoperation.
Conclusion:
Minimal esophagus dissection without hiatal closure in LNF avoids dysphagia with no increase in the rate of recurrence and complications.
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