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The uncut Collis-Nissen fundoplication: results for 79 consecutively treated high-risk children
B H Cameron1, W J Cochran, C W McGill
1Department of Pediatric Surgery, Geisinger Clinic, Danville, PA, USA.
Insights
The uncut Collis-Nissen fundoplication effectively controls gastroesophageal reflux (GER) in children, even those with complex conditions like neurological impairment or chronic lung disease. This surgical approach offers a high success rate with manageable complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Reflux Management
Background:
- Nissen fundoplication is insufficient for controlling gastroesophageal reflux (GER) in up to 25% of pediatric patients with neurological impairment or chronic lung disease.
- The uncut Collis modification aims to improve antireflux function by lengthening the intraabdominal esophagus without gastric division.
Purpose of the Study:
- To review the outcomes of the uncut Collis-Nissen fundoplication in a series of pediatric patients.
- To evaluate the efficacy and safety of this surgical technique for managing GER in a challenging pediatric population.
Main Methods:
- A retrospective review of 79 children who underwent uncut Collis-Nissen fundoplication over a 5-year period.
- Patients had objective evidence of GER complications unresponsive to medical treatment, with common comorbidities including neurological impairment and chronic lung disease.
- Preoperative assessment included liquid gastric emptying, with concomitant pyloroplasty performed in 42% of patients with delayed emptying.
Main Results:
- Excellent GER control was achieved in 97% of patients at a median follow-up of 1.8 years.
- Recurrent GER was documented in only two patients, with one requiring reoperation.
- Postoperative complications occurred in 26% of patients (3% major), and there was one operative mortality; 11 late deaths were unrelated to the procedure or GER.
Conclusions:
- The uncut Collis-Nissen fundoplication is a highly effective procedure for controlling GER in children.
- The technique is associated with acceptable morbidity and low mortality, making it a valuable option for pediatric patients, especially those with neurological impairment or chronic lung disease.
Purpose:
The Nissen fundoplication fails to control gastroesophageal reflux (GER) in up to 25% of children with neurological impairment or chronic lung disease. The uncut Collis modification lengthens the intraabdominal esophagus, improving the antireflux function without opening the stomach. This study reviews the results of the uncut Collis-Nissen fundoplication in a pediatric series.
Methods:
Seventy-nine children had an uncut Collis-Nissen fundoplication performed over a 5-year period. The median age was 1.4 years. Associated problems included neurological impairment (77%), chronic lung disease (38%), and esophageal atresia (3%). Surgery was undertaken only in children with objective documentation of pathological GER, who had GER complications unresponsive to medical treatment. The usual complications that led to surgery were pulmonary (73%), esophagitis (67%), or failure to thrive (35%). Liquid gastric emptying was assessed routinely preoperatively, and was delayed in 42% patients who then had concomitant pyloroplasty.
Results:
GER was controlled in 97% of patients after a median follow-up of 1.8 years. All children with recurrent symptoms were restudied, and only two children had documented recurrent GER. One of these required a repeat fundoplication. Thirty-three percent were on promotility medication for feeding difficulties, gagging, or retching. There were postoperative complications in 26% (minor 23%, major 3%) and one postoperative mortality. Eleven late deaths were unrelated to surgery or GER.
Conclusion:
The uncut Collis-Nissen fundoplication provides excellent control of GER in children and is associated with acceptable morbidity and low mortality. It should be particularly considered in children with neurological impairment or chronic lung disease.