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Oral Presentation - 2
Reconstruction of the phrenoesophageal ligament: An alternative to avoid post-fundoplication paraesophageal hernia in children.
Carlos Garcia-Hernandez, Lourdes Carvajal-Figueroa, Ariadna Alvelais-Arzamendi, Carlos Aguilar-Gutierrez
Universidad Nacional Autónoma de México
Background: Paraesophageal hernia due to migration towards the thorax of Nissen fundoplication is a common complication of antireflux surgery. It occurs in up to 12% of children undergoing fundoplication surgery. This requires that an adequate portion of intra-abdominal esophagus be obtained, so the phrenoesophageal membrane must be incised. The objective is to evaluate the effectiveness of reconstruction of the phrenoesophageal membrane to prevent paraesophageal hernia in children undergoing fundoplication surgery.
Methods: Retrospective cohort study involving 690 children undergoing laparoscopic fundoplication, cohort one without membrane reconstruction (non-exposed group) while cohort two underwent membrane reconstruction. (Exposed group) The outcome was the appearance of a postoperative paraesophageal hernia. Odds ratios (OR) and 95% confidence intervals (CI) were calculated at p ≤ 0.05. This work was approved by the Hospital's research committee.
Results: A total of 631 patients, 52.1% in Cohort 1 and 47.9% in Cohort 2. Herniation occurred in 7.0% of Cohort 1 and 1.3% of Cohort 2 (p < 0.001). Phrenoesophageal reconstruction in Cohort 2 resulted in an 82.1% reduction in the likelihood of migration (OR 0.179, 95% CI 0.06-0.52).
Conclusion: This study highlights the importance of carrying out a reconstruction of the phrenoesophageal membrane, when performing a fundoplication in children, which significantly reduces the appearance of postoperative esophageal hernias.