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Paraesophageal hernia: a major complication of Nissen's fundoplication
Insights
Surgical treatment for gastroesophageal reflux can lead to paraesophageal hernia, especially in children. The optimal surgical approach for reflux, with or without hiatal hernia, remains uncertain, highlighting the need for careful patient selection.
Area of Science:
- Gastroenterology
- Pediatric Surgery
Background:
- Paraesophageal hernia is a significant complication following surgical treatment for gastroesophageal reflux (GER) via fundoplication.
- This complication is notably more prevalent in the pediatric population.
Purpose of the Study:
- To evaluate the uncertainty surrounding the best surgical treatment for GER, particularly when a hiatus hernia is present.
- To emphasize the importance of precise indications and accurate conservative treatment in managing GER, especially in children.
Main Methods:
- Review of surgical outcomes for gastroesophageal reflux.
- Analysis of complication rates, specifically paraesophageal hernia, in pediatric patients.
- Consideration of factors influencing surgical approach selection.
Main Results:
- Paraesophageal hernia is a predominant complication in pediatric patients undergoing surgical GER treatment.
- The optimal surgical strategy for GER, with or without hiatus hernia, is not definitively established.
- Spontaneous improvement in GER, particularly in infants, influences the necessity and timing of surgical intervention.
Conclusions:
- The choice of surgical technique for GER should be guided by precise indications.
- Accurate nonoperative management is crucial for determining the need for surgery in children.
- Careful consideration of potential complications and spontaneous remission is essential for successful GER treatment.
Abstract:
Paraesophageal hernia was a major complication in a number of patients who were treated surgically for gastroesophageal reflux by fundoplication. This major complication seems to be predominant in the pediatric age group. The best surgical treatment for gastroesophageal reflux, whether a hiatus hernia is involved or not, is still uncertain. As with many other surgical problems where we must find a compromise, several surgical techniques are adopted. The choice of the surgical approach may depend upon the indications. As the indications for surgery are precise, the results must be reached with the utmost certainty, particularly hen complications already exist (esophagitis, stricture). The results of operative treatment of gastroesophageal reflux are in part, at least, influenced by the considerable tendency to spontaneous improvement, particularly in infants. In most cases, nonoperative treatment is initially undertaken if there are no prior complications. The number of children who are surgically treated depends to a great extent upon the accuracy of this conservative treatment.