Reconstruction of the Phrenoesophageal Ligament: An Alternative to Avoid Post-Fundoplication Paraesophageal Hernia in Children

Abstract

Purpose: Migration of Nissen fundoplication to the thorax is a frequent complication of antireflux surgery. Occurring in up to 12% of children. Achieving adequate intra-abdominal esophageal length requires dissection of the phrenoesophageal membrane. The primary objective of this study was to assess the effectiveness of phrenoesophageal membrane reconstruction in preventing thoracic migration of the fundoplication in children undergoing laparoscopic surgery.

Methods: Retrospective cohort study of 690 children undergoing laparoscopic fundoplication, Group A without membrane reconstruction, and Group B with membrane reconstruction. The outcome was intrathoracic migration of the postoperative fundoplication. Odds ratio (OR) and 95% confidence intervals (CI) were calculated with p ≤ 0.05.

Results: A total of 631 patients met inclusion criteria, 52.1% in Group A and 47.9% in Group B. Intrathoracic migration occurred in 7.0% in Group A 
and 1.3% in Group B (p < 0.001). Phrenoesophageal reconstruction in Group B 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 need to perform a reconstruction of the phrenoesophageal membrane when performing a fundoplication in children, which significantly reduces the intrathoracic migration of fundoplication.