Characterization and management of paraesophageal hernias in children after antireflux operation

• Published in: Journal of pediatric surgery 1999-11, Vol.34 (11), p.1610-1614
• Main Authors: Avansino, Jeffrey R, Lorenz, Mary L, Hendrickson, Margo, Jolley, Stephen G
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Digestive System Surgical Procedures - methods; Esophagus; Female; Follow-Up Studies; Fundoplication - adverse effects; Fundoplication - methods; Gastric Emptying - physiology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - surgery; Hernia, Hiatal - epidemiology; Hernia, Hiatal - etiology; Hernia, Hiatal - surgery; Humans; Incidence; Infant; Infant, Newborn; Male; Medical sciences; Other diseases. Semiology; Prognosis; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(99)90627-9

Purpose: The aim of this study was to determine the important factors in the development and subsequent treatment of postoperative paraesophageal hernia (PPEH). Methods: A retrospective analysis was performed in 464 consecutive children (ages 3 days to 18 years) for PPEH after a primary antireflux operation performed at a Children's Hospital and University Hospital between 1985 and 1997. All operations included a crural repair, but the Nissen fundoplication was performed with (n = 162) and without (n = 70) plication of the esophagus to the crus at 3 points. Patients with and without PPEH were compared with respect to the type of antireflux operation, the patient's age at operation, and the preoperative and postoperative clinical courses. A preoperative corrected gastric emptying value was obtained from a radionuclide gastric emptying study in 289 patients. The treatment of PPEH also was examined. Results: The incidence of PPEH in our patients was 4.5% (21 of 464). Although there was a lower incidence of PPEH in patients with crural plication compared with patients without crural plication during Nissen fundoplication (5 of 162, 3% v 7 of 70, 10%; P = .035), 2 patients with crural plication had a postoperative esophageal leak. Patients with PPEH had a significantly increased prevalence of gagging before the initial antireflux operation compared with patients without PPEH (3 of 21, 14.3% v 7 of 443, 1.6%; P = .007). A higher prevalence of slow corrected gastric emptying preoperatively also was seen in patients with PPEH compared with patients without PPEH (8 of 15, 53% v 79 of 274, 29%; P = .046). The prevalences of central nervous system disease, young age (