Relapse of children's hiatus hernia and related factors concerning reoperation

Abstract

Objective To explore the factors which are related to the reoperation and relapse hiatus hernia in children. Methods Between Jan.2002 and May 2013, 64 patients who suffered from hiatus hernia in Children's Hospital of Fudan University were divided into uneventful group(U group, n=49) and reoperation group(R group, n=15). The ages at operation, barium swallow examinations, operative procedures, findings during the operation and the follow-up of these two groups were reviewed. Results The average ages at operation in U group and R group were (14.70±0.79) months and (13.60±0.59) months, respectively.The major symptoms before the second operation in R group was vomiting(6 cases), pneumonia(4 cases) and dysphagia(2 cases). Asymptomatic recurrence was found in 3 patients.Through barium swallow examination, short was found in 10 cases in U group, while 3 cases were reported in R group.However, during the operation, the length of intra-abdominal without tension could be obtained with average (3.33±0.86) cm in these short esophagus patients, which was only (3.18±1.14) cm in those normal esophagus patients.There was no significant difference between the U group and R group in the width of the hiatus and the ratio of stomach above the hiatus.The length of which mobilized during operation was shorter in R group than that in U group(P=0.003). The difference of operative methods and the ratio of large hernia between these two groups could not be found.The common cause of failure in R group was herniated fundoplication(9 cases), which was followed by disputed fundoplication(4 cases), twisted fundoplication(1 case) and rupture of esophagus(1 case). The average follow up time was (8.3±4.2) months in R group.Vomiting was found in 3 patients, and pneumonia was found in one case in R group after the second operation.The symptoms of these four patients were relieved half year later postoperatively. Conclusions The age, symptoms, size of the hiatus, short esophagus, and the operative met-hods are not related to the reoperation in hiatus hernia.But if the length of intra-abdominal without tension was not obtained enough, it may contribute to the recurrence of hiatus hernia.Wrap herniation has now become the most common mechanism of failure requiring reoperation. Key words: Hiatus hernia; Reoperation; Recurrence; Short esophageal