Intraoperative findings in children with transthoracic wrap migration

Abstract

IntroductionA frequent complication of Nissen fundoplication procedure is the migration of the wrap towards the thorax. The minimal paraesophageal dissection proposed by St. Peter has led to a significant decrease in this complication. This paper aims to report the intraoperative findings in children who presented with transthoracic wrap migration to try to establish the mechanisms that cause this condition. MethodsAn IRB exempt review of children with transthoracic wrap migration. Demographic factors, radiological findings, endoscopic and intraoperative findings were analyzed. Descriptive statistics were employed as measures of relative and central frequency. ResultsIn 10 years, 47 patients were treated. The migration of the wrap occurred at 37.61 months on average. In 95.21% of children, the migration occurred in the anterior part of the hiatus. This was also associated with a short esophagus in 8.5% of patients. DiscussionWe found that in over 90% of patients the migration occurred in the anterior part of the hiatus, which corresponds to the phrenoesophageal ligament. This reinforces the importance of keeping the ligament intact through minimal dissection, or if dissection is absolutely necessary, the phrenoesophageal ligament should be reconstructed. Level of evidenceII-B