INTRODUCTION: A 6 year old with a history of a tracheosophageal fistula presents with a history problematic for recurrent hiatal hernias and severe gastroesophageal reflux. He underwent a laparoscopic Nissen fundoplication at 3 months of age. He had continued reflux and strictures and underwent a revision Nissen fundoplication with repair of a hiatal hernia at 3 ½ years of age. However, persistent reflux with recurrence of his hiatal hernia and resulted in 2 additional revisions with a diaphragmatic patch and subsequent crual patch at 4 1/2 and 5 years of age, respectively.
METHODS: Through a total abdominal intracorporeal technique using 5 ports (4-5mm and 1 12mm), esophageal lengthing was accomplished and a new intra-abdominal gastroesophageal junction was created via Collis-Nissen technique. Operative time was 180 minutes.
RESULTS: The patient recovered well and was discharged home. He had complete resolution of his symptoms.
CONCLUSION(S): Total intracorporeal laparoscopic revision of a Nissen fundoplication for recurrent reflux and hiatal hernias is feasible and safe in the pediatric patient. It should be considered as an alternative approach to the surgical management of patients with a history of tracheoesophageal repair with recurrent gastroesophageal reflux, hiatal hernias, with a presumed diagnosis of a short esophagus
Session: Podium Video Presentation
Program Number: V013