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Hiatal Hernia
Everything in the library about hiatal hernia — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Surgical Management
2 items
Lap Nissen trinity narrated
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Surgical content by Dr. Steve Rothenberg — Abdominal Surgery
video5:55 · May 2026
percuvance redo nissen
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Surgical content by Dr. Steve Rothenberg — Abdominal Surgery
video5:16 · May 2026
In-Depth Reviews
1 item
Gastroesophageal Reflux: Contemporary Management Pediatric Surgery Update...
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Dr. Timothy Kane, chief of general and thoracic surgery at Children's National Medical Center, Washington D.C., discusses gastroesophageal reflux.His presentation of clinical cases includes Collis Nissen fundoplication to lengthen the esoph
video32:14 · Sep 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Gastroesophageal Reflux: Contemporary Management Pediatric Surgery Update...
Multiple-channel intraluminal impedance probes are the best test for quantifying the presence and severity of non-acid reflux over time.
clinicalTim0:08 ↗
Impedance probes are not readily available to all practitioners, particularly outside major centers, and even within the United States not all pediatric gastroenterologists perform them.
clinical0:38 ↗
pH probes are more readily available and more commonly used than impedance probes for reflux evaluation.
clinical0:38 ↗
Gastroenterologists report they can perform impedance studies in neonates, although they are rarely requested.
clinicalTim1:04 ↗
Surgical decisions to operate for reflux are typically based on clinical symptoms rather than objective testing.
clinicalTim1:04 ↗
In a study from the speaker's institution examining fundoplications and correlating upper GI studies with pH studies, the upper GI influenced management in 4% of cases.
epidemiologicalTim4:20 ↗
Of the 4% of cases where upper GI influenced management, 80% were due to detection of malrotation.
epidemiologicalTim4:20 ↗
The 4% rate of upper GI studies influencing management can be interpreted two ways: either 4% is significant enough to warrant routine pre-operative upper GI, or 4% is low enough that malrotation can be evaluated intraoperatively during fundoplication.
opinionTim4:20 ↗
If pre-operative upper GI demonstrates malrotation in a patient being evaluated for fundoplication, management changes from fundoplication to Ladd procedure with proton pump inhibitors instead.
clinicalTim5:26 ↗
Upper GI studies can also detect duodenal web or duodenal stenosis in addition to malrotation, though malrotation was the most common reason for management change.
clinicalTim5:47 ↗
For a 3-year-old child who is eating orally, gastrostomy tube placement is not routinely indicated at the time of fundoplication.
clinical3:45 ↗
Collis gastroplasty is not necessary for routine fundoplication with hiatal hernia repair in pediatric patients.
clinical2:24 ↗
Pyloroplasty is not routinely performed at the time of fundoplication.
clinical3:00 ↗
For patients who tolerate nasogastric tube feeds without vomiting, gastrostomy tube alone may be sufficient without fundoplication.
clinical3:00 ↗
For patients who continue to vomit despite nasogastric tube feeds, fundoplication (Nissen) is indicated.
clinical3:00 ↗
In 2013, laparoscopic approach should be the default for fundoplication rather than open approach.
opinionTim6:43 ↗
For type 2 (paraesophageal) hiatal hernias in children, fundoplication and hiatal hernia repair alone is adequate without gastropexy or gastrostomy tube.
clinical12:45 ↗
Once a paraesophageal hernia is reduced and fundoplication performed, gastropexy does not appear necessary based on available data.
clinical12:45 ↗
In gastroschisis patients being re-operated at 6 months of age, there are often not many adhesions present, making laparoscopic approach feasible.
clinical15:00 ↗
For gastroschisis patients requiring fundoplication, left upper quadrant initial port placement via mini cut-down is preferred over umbilical access to avoid adhesions.
clinical15:00 ↗
In neurologically normal 6-month-old infants with reflux, there may be justification to wait longer before proceeding to fundoplication since they may still outgrow reflux.
opinionTim16:38 ↗
Laparoscopic approach can be successfully attempted even in patients with previous abdominal operations, as adequate visualization can usually be achieved with patience.
clinical16:59 ↗
For redo fundoplication after prior laparoscopic Nissen, laparoscopic approach is preferred as visualization is often better than with open technique, even in the upper abdomen.
clinical18:11 ↗
Laparoscopic anti-reflux operations are well-tolerated by infants with cardiac anomalies.
clinicalTim22:16 ↗
Wrap herniation above the diaphragm is NOT more common in the open group compared to laparoscopic (contrary to what might be expected).
clinicalTim22:16 ↗
Postoperative bowel obstruction rates are significantly lower with laparoscopic fundoplication compared to open approach.
clinicalTim22:37 ↗
Traditional rates of postoperative bowel obstruction after open fundoplication were quoted as 5-10%.
epidemiological22:37 ↗
Current estimated rate of postoperative bowel obstruction after laparoscopic fundoplication is approximately 1-2%.
epidemiological22:37 ↗
For laparoscopic fundoplication, ports are placed higher in the abdomen, which may contribute to even lower bowel obstruction rates than general laparoscopic surgery.
clinicalTim22:52 ↗
Neurologically impaired children who develop adhesive bowel obstruction after fundoplication may present late and very ill because they have a closed-loop obstruction with inability to vomit.
clinical23:01 ↗
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