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BOB Ped Surg 2023 - Mohamad Qinawy, PAPSA - Presentation
With Dr. Mohammed Qinawy
Chapter 1 of 5 · Evidence & Research
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Introduction and study background
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What the experts said
Nissen fundoplication is the most commonly adopted procedure for GERD all over the world
Post-operative bloating is frequently encountered after Nissen fundoplication, raising the necessity for a more physiologic design
Recurrent GERD 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 first step of Helio procedure 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 of His is established by suturing the fundus of the stomach to the length of the esophagus with running absorbable suture (Vicryl or silk)
The last suture in Helio procedure incorporates the stomach, the phrenic ligament, the crura, and the proximal part of the abdominal esophagus
Inclusion criteria included patients with GERD with failure of medical treatment, symptomatic hiatus hernia, esophageal stricture, and life-threatening symptoms like apnea
Exclusion criteria included recurrent cases, giant paraesophageal hernia, and gastroparesis
Operative time was significantly longer in the Helio group when compared to the Nissen group
Early post-operative bloating was found to be lower in the Helio group: 3 cases versus 15 cases in Nissen
Early dysphagia was found to be lower in the Helio group: 2 cases versus 7 cases in Nissen
Early vomiting was encountered more in the Nissen group: 6 cases versus 2 cases in Helio
Time to start oral feeding was insignificant between both groups but was shorter duration in the Helio group
Late post-operative assessment found no bloating in any Helio patient while 11 cases from Nissen group suffered from bloating
Recurrent vomiting and need for drugs was found in 8 Nissen cases versus 6 Helio cases
There were 3 recurrent Helio cases versus 2 Nissen cases
The recurrent Helio cases were found in the first 10 cases, which was attributed to the learning curve
Helio procedure offers an effective alternative to Nissen fundoplication with no bloating and much less dysphagia, and earlier return to normal eating pattern