C01590-01 C Why?
¨June 1993 to December 2005¨118 patients with failed fundoplications¨Ages 6 months to 19 years (Avg. 7 yrs)¨Weight 6.4 Kg to 88 Kg¨65 previous open fundoplications ¨53 previous laparoscopic Surg Endosc (20) 1518-20. 2006
OPEN¨52 Nissen¨12 Thal¨1 Toupet ¨Hiatal Hernia: 68%¨19 patients more then 1 previous fundoplication LAPAROSCOPIC¨50 Nissen (32 SSR)¨3 Thal¨1 Toupet
¨Pain/ Heartburn (78%)¨Dysphagia (10%)¨Pulmonary complicationsworsening RAD (14%) Work-up¨UGI¨EGD¨pH probe
¨Closed insertion¨Alternate site when necessary¨4 or 5 port technique¨Enterolysis¨Re-establish intra-abdominal esophagus¨Repair Hiatal Defect¨Redo Wrap
¨Operative time: 35 to 195 minutes Avg. 100 minutes¨Conversion rate: 0¨Intra-operative complication rate: 1.0%¨Average time to full feeds: 1.8days¨Average hospital stay: 2.2 days
7 TIF 2 Plicates Esophagus
¨Less invasive/ No scars¨Doesn’t take down natural attachments of the stomach and GE-Jct. ? Fewer hiatal hernias¨Less dysphagia, gas bloat, gagging and retching¨More attractive to patients on chronic medication who aren’t ready for “surgery”¨Maybe repeated and doesn’t prevent later laparoscopic fundoplication
¨Size: requires at least 20 to 25 kg child¨Incomplete wrap (240 vs 360)¨? Durability¨No long term outcomes available yet
¨ When endoscope reaches stomach, retroflex to observe device entry ¨ Advance device elbow past GEJ ¨ Align back of mold with lesser curve ¨ Retract endoscope, loop released ¨ Close tissue mold ½ way ¨ Advance endoscope and retroflex ¨ Close tissue mold fully ¨ Connect invaginator tubing 10
¨Smallest – about 23 kg¨15 USA¨15 Sheffield England
¨All discharged in under 24 hours¨Soft diet for 1 week¨One patient with mild dysphagia for 7 days¨All patients asymptomatic¨pH normalized (<1%) at 8 weeks in all patients studied to date.