Nowadays laparoscopic Nissen
fundoplication represents the gold standard in surgical treatment of complicated
Gastro-Esophageal-Reflux Disease (
GERD), above all in
cerebral palsy patients. In non-neurological patients without
gastrostomy Nissen
fundoplication can create some problems (
gas bloat syndrome,
dysphagia). Laparoscopic Hill-Snow repair is an established surgical alternative, but it is reported only in adult population. We describe our modification of Hill-Snow technique and our experience in a large series of non-neurological children in order to report its effectiveness and applicability in pediatric patients affected by complicated
GERD. Between 2000 and 2022, 319 children underwent surgical correction of
gastro-esophageal reflux at our Department. All were affected by complicated
gastro-esophageal reflux unresponsive to PPI (
Proton Pump Inhibitors). 251 underwent laparoscopic Nissen
fundoplication; 68 non-neurological patients underwent laparoscopic Hill-Snow repair. Of these 68 children 48 were males (71%) and 20 females (29%); median age was 5years (3 months-11 years). Weight range was 4-37kg. 52 patients (76.5%) presented the following symptoms: retrosternal
pain,
dysphagia, regurgitation, coughing,
failure to thrive, persisting
reflux esophagitis. 16 (23.5%) had chronic respiratory problems (aspiration, apneic-spells,
dysphagia, coughing,
choking,
gagging). For 8 (11.8%) symptoms were expression of chronic recurrent
gastric volvulus. All underwent modified-laparoscopic-Hill-Snow repair. Contrast study showed
sliding hiatal hernia in 55 patients (81%), while endoscopy demonstrated 16 cases of histologically severe
esophagitis (23.5%) and 52 of mild
esophagitis (76.5%). No intraoperative/postoperative complications were recorded. 60patients had a complete follow-up (range 1-20 years). 60/68 patients were evaluated with
barium-swallow-study at 6-12 months; 40/68 patients with upper-gastrointestinal-endoscopy at 12months. No relapse was reported. 50 patients (73.7%) were symptom-free. 18 (26.3%) referred occasional epigastric
pain, associated with vomit in 2 cases. 64 (94.1%) referred ability to vomit; 4 temporary difficulty to swallow (average 30 days). All patients reported being able to burp. 3(4.5%) presented episodes of gas-air-bloat during the first 2 months with spontaneous resolution. No case of
dumping syndrome was recorded. This technique's modification yields excellent results in term of relapse and side effects at long-term follow-up. We reported the first and largest pediatric series in non-neurological children with encouraging results.