Laparoscopic Collis-Nissen for recurrent severe reflux in pediatric patients with esophageal atresia and recurrent hiatal hernia

Abstract

Purpose: Patients following esophageal atresia repair may often have a congenitally short esophagus, leading to severe reflux and failed fundoplications. This report evaluates the efficacy of a laparoscopic Collis-Nissen fundoplication in this group of patients who have failed a previous fundoplication.

Methods: From January 2005 to February 2010, 6 patients born with esophageal atresia presented with recurrent gastroesophageal reflux disease (GERD) and hiatal hernia (H/H). Patient's ages ranged from 5 to 12 years and weights from 17 to 32 kg. All patients had undergone at least three previous fundoplications and hiatal hernia repair. Four of 5 patients had at least one open laparotomy for their previous repair. Patient 6 had had a previous open Collis gastroplasty. The procedure was performed through five ports and consisted of a takedown of the previous fundoplication, elongation of the esophagus using an endoscopic stapler, closure of the hiatus using Teflon pledgets to buttress the repair, and formation of the fundoplication.

Results: All procedures were completed successfully laparoscopically. Procedure times ranged from 180 to 300 minutes. A nasogastric (NG) tube was left for an average of 3 days in 5 patients. Patient 6 had a delayed perforation on day 3 and required reexploration and an NG tube that was left for 10 days. Five of 6 patients were started on feeds on day 4 and were discharged on day 5. Patient 6 with the perforation was discharged on day 14. At an average follow-up of 42 months, all patients have intact wraps and no recurrence of their hiatal hernia.

Conclusions: A laparoscopic Collis-Nissen in a child with previous failed fundoplication is a complex, but efficacious, procedure. Elongating the esophagus in patients with esophageal atresia may decrease the high recurrence rate of hiatal hernia in these patients and should be considered if the patient fails their primary repair.