The most common abnormalities seen after anti-reflux surgery in children

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Cuthbert McGee
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1 The most common abnormalities seen after anti-reflux surgery in children Poster No.: C-1580 Congress: ECR 2012 Type: Educational Exhibit Authors: S. R#czkowska; Warsaw/PL Keywords: Pediatric, Esophagus, Gastrointestinal tract, Fluoroscopy, Contrast agent-oral, Eating disorders DOI: /ecr2012/C-1580 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 13

2 Learning objectives To illustrate the most common complications occurring in children after laparoscopic and open Toupet partial fundoplication. In this poster we will present variety of images found during examination of upper gastrointestinal tract with barium swallow, carried out in our clinic in Childrens Health Memorial Institute in Warsaw. Background Toupet fundoplication is the most common anti-reflux surgery performed in Childrens Health Memorial Institute. In our Institute nearly 50 procedures a year are made.this kind of surgery is usually reserved for patients with complication of reflux esophagitis, reflux runs with frequent upper respiratory tract infections or episodes of bronchospazm, continued reflux despite medical therapy,hiatal hernia. It is also performed in children with neurological disfunction, specially when indications for gastrostomy are established. Toupet fundoplication treatment consist of few stages.firstly abdominal part of esophagus must be mobilized and size of esophageal hiatus narrowed. In the next step the fundus of stomach is wrapped around the lower lower part of esophagus and sutured in place. This creates kind of valve in shape of the cuff on the 3/4 of posterior part of esophagus. Last step is deepening of Hiss angle by sewing the front part of the fold of the gastric fundus to the anterior surface of the esophagus and adjacent parts of hiatus hernia ( Fig.1). Images for this section: Page 2 of 13

3 Fig. 1: Toupet fundoplication technique Page 3 of 13

4 Imaging findings OR Procedure details Fluoroscopy with oral barium admission allows to visualize the upper gastrointestinal tract. In case of recurrence of typical symptoms of disease in the form of burping, regurgitation, burning in the esophagus, chest or abdominal pain this procedure can be performed. In patients undergoing Toupet fundoplication frequently appears postoperative dysphagia. This problem can be caused by inadequatly tight fundoplication cuff ( Fig.2, Fig.3). Inadequate mobilization of esophagus or leaving too wide esophageal hiatus can be the reason for another encountered appearence-paraesophageal hernia. Displacement of the fundoplication cuff (and even stomach) to mediastinum can be observed during barium swallow (Fig.4, Fig. 5). Sliding hernia can be seen more exceptionally. The cause of this appearence can be slipping of the fundoplication cuff or improper esophagus mobilization (Fig.6, Fig. 7). Improperly fixed, too wide fundoplication cuff is the main reason for early recurrence of gastroesophageal reflux and typical symptoms of this disease (Fig. 8, Fig. 9). Images for this section: Page 4 of 13

5 Fig. 2: Anteroposterior upper GI shows significant stricture of the lower part of the esophagus after Toupet fundoplication. Swallowing dysfunction. Page 5 of 13

6 Fig. 3: Lateral upper GI shows stricture of the lower part of the esophagus after Toupet fundoplication. Swallowing dysfunction. Page 6 of 13

7 Fig. 4: Lateral upper GI shows hiatal herniation of the stomach and wrap in patient after Toupet fundoplication. Page 7 of 13

8 Fig. 6: Anterioposterior upper GI shows elevation of the part of abdomen above the diaphragm valve in this patient with a sliding type of hiatal hernia - after Toupet antireflux surgery. Page 8 of 13

9 Fig. 7: Anterioposterior upper GI shows elevation of the part of abdomen above the diaphragm valve in this patient with a sliding type of hiatal hernia - after Toupet antireflux surgery. Page 9 of 13

10 Fig. 8: Anterioposterior upper GI shows reflux of contrast into esophagus Page 10 of 13

11 Fig. 9: Anterioposterior upper GI shows reflux of contrast into esophagus. In this patient sliding type of hernia is also seen Page 11 of 13

12 Fig. 5: Lateral GI shows paraesophageal type of hernia in patient after Toupet surgery Page 12 of 13

13 Conclusion Despite developement of minimally invasive surgery to treat gastroesophageal reflux there are still some complications seen.the aim of this presentation is to introduce and illustrate the most common abnormalities found in children after Toupet surgery. All presented examinations were registred during our work in Childrens Health Memorial Institute. Personal Information Sylwia R#czkowska, E.Jurkiewicz, M.P#dich References Diagnostic Imaging. Pediatrics Lane F. Donnelly...[et al.]. Canada ISBN Chirurgia dzieci#ca - J.Czernik. Wroc#aw ISBN L.Spitz, G.M.Steiner, R.B.Zachary. A Colour Atlas of Paediatric Surgical Diagnosis. Netherlands ISBN Page 13 of 13

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