Partial gastric wrap-around as an alternative procedure in the treatment of hiatal hernia

The Allison, Belsey, and Nissen antireflux operations have been widely used over the last 15 yr. A number of problems have followed from these procedures that have prompted us under certain circumstances to seek alternative operations. In the last 2 yr, in selected patients, we have done a partial gastric wrap-around (Dor-Nissen) operation on 16 children from age 2 wk to 13 yr for the following reasons: failed Allison and Nissen repairs, two infants with such a small stomach that only a partial stomach wrap-around was possible, with a Heller cardiomyotomy, and for reflux with or without an accompanying hiatal hernia. All of these Dor-Nissen partial wrap-around operations were technically easy to do and all the postoperative patients have been problem-free both clinically and radiologically. Moreover, the gass bloat syndrome seen with the Nissen fundoplication has not been encountered. We recommended this partial wrap-around antireflux operation as a primary procedure, an alterative to one of the more widely used operations, or when re-operating for recurrence of gastroesophageal reflux.