Extended hiatoplasty: early experience with a simple technique to increase the intraabdominal esophageal length in complicated gastroesophageal reflux.
OBJECTIVE
The aim of this paper is to describe the experience of the Division of Pediatric Surgery of State University of Campinas Medical School with a simple technique of extended hiatoplasty to achieve intraabdominal placement of the distal esophagus in difficult situations.


METHODS
From April 1997 to November 1999, 7 patients who had either complicated or recurrent gastroesophageal reflux (GER) underwent open (2 patients) or laparoscopic (5 patients) correction of GER that included an extended hiatoplasty. All had undergone previous unsuccessful clinical or surgical treatment. To investigate the severity of the disease, diagnostic endoscopy or barium swallow were performed before surgery. Postoperatively, these children underwent clinical evaluation or any additional diagnostic procedure deemed necessary.


RESULTS
Using the extended hiatoplasty, a good length of intraabdominal esophagus could be achieved in every patient. No complications resulted from the procedure itself. There was a late instance of paraesophageal hernia with recurrence of GER attributable to disruption of the hiatoplasty, which was rerepaired through a laparoscopic approach. Symptomatic improvement was observed in all but the patient with caustic stricture.


CONCLUSIONS
Extended hiatoplasty is a simple maneuver that may represent a good option to increase the length of intraabdominal esophagus in patients with a short esophagus secondary to severe GER disease, being associated with a high success rate and low morbidity. J Pediatr Surg 36:555-558.
Division of Pediatric Surgery, State University of Campinas Medical School, Rua Alexandre Fleming, 181, 13083-970, Campinas-SP-Brazil.
J
J
Bustorff-Silva
A P
AP
Moreira
M A
MA
Cavalaro
A A
AA
Melo Filho
D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004947:Esophagus / Q000033:anatomy & histology / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome