Ergun Ergun, Gollu Gulnur, Ates Ufuk, Yagmurlu Aydin
Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
North Clin Istanb. 2021 May 24;8(3):222-225. doi: 10.14744/nci.2020.10693. eCollection 2021.
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.
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.
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.
Minimal esophagus dissection without hiatal closure in LNF avoids dysphagia with no increase in the rate of recurrence and complications.
腹腔镜尼森胃底折叠术（LNF）的一个重要部分是合适的包绕，而这只有在对食管和裂孔进行恰当的解剖后才有可能实现。然而，为获得足够长度的食管而对食管和裂孔进行过多的解剖会增加发病率。本研究的目的是分析LNF中最小限度食管解剖对复发和术后裂孔疝的影响。
本研究纳入了2008年至2016年间接受LNF且食管解剖最小限度且未进行裂孔闭合的0至18岁儿童。对患者的病历进行回顾性分析，并就复发和术后裂孔疝进行评估。
共有143名儿童。平均年龄为4.5±4.6岁（20天至17岁）。约54%的儿童（n = 78）存在神经功能障碍。有两例无需手术的暂时性肠梗阻，一例经一次扩张治疗后缓解的食管狭窄，以及一例因裂孔疝复发而需要再次手术的病例。
LNF中最小限度食管解剖且不进行裂孔闭合可避免吞咽困难，且不增加复发率和并发症发生率。
