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BOB Ped Surg 2023 - Mohamad Qinawy, PAPSA - Presentation
With Dr. Mohammed Qinawy
Chapter 1 of 5 · Fundamentals
Study rationale
Introduction and study rationale
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What the experts said
Nissen fundoplication is the most commonly adopted procedure for GERD all over the world
Post-operative dysphagia and bloating are frequently encountered after Nissen fundoplication
Current GERD recurrence after anti-reflux surgery has been reported to occur in up to 15% of children requiring re-operation
The study was a prospective single-blinded randomized comparative study conducted from October 2018 to April 2020 including 40 patients divided into two groups
The Helio procedure first step is fixation of the distal abdominal esophagus to the crura with non-absorbable sutures (1 or 2 sutures) to maintain the abdominal esophagus inside the abdomen
The angle in the Helio procedure is established by suturing the fundus of the stomach to the length of the esophagus with running absorbable suture (Vicryl or silk)
In the Helio procedure, the last suture incorporates the stomach, phrenic ligament, crura, and proximal part of the abdominal esophagus
The fundus is fixed to the diaphragm with 1 or 2 sutures in the Helio procedure
Air insufflation is performed to test for gastric competence at the end of the Helio procedure
Study inclusion criteria were patients with GERD failing medical treatment, symptomatic hiatus hernia, esophageal stricture, or life-threatening symptoms like apnea
Study exclusion criteria were recurrent cases, giant paraesophageal hernia, and esophageal atresia
Operative time was significantly longer in the Helio group compared to the Nissen group
Early post-operative bloating was lower in the Helio group (3 cases) versus Nissen group (15 cases)
Early dysphagia was lower in the Helio group (2 cases) versus Nissen group (7 cases)
Early vomiting was more common in the Helio group (6 cases) versus Nissen group (2 cases)
Hospital stay duration was insignificant between both groups but was shorter in the Helio group
Late post-operative bloating was found in 0 Helio cases versus 11 Nissen cases
Recurrent vomiting requiring anti-reflux medication was found in 6 Helio cases versus 8 Nissen cases
There were 3 recurrent Helio cases versus 2 recurrent Nissen cases
The 3 recurrent Helio cases were found in the first 10 cases, attributed to the learning curve
The Helio procedure offers an effective alternative to Nissen fundoplication with no bloating, much less dysphagia, and earlier return to normal eating pattern