Fundoplication with anastomotic wrap : A modification of a Nissen procedure to achieve permanence.

Gastric fundoplication is an accepted treatment for disabling or life-threatening gastro-oesophageal reflux in childhood, and a modified Nissen's procedure is most commonly used. Wrap failure is a common complication and occurs most frequently and earliest in neurologically impaired children. To obviate this complication, the procedure was modified by anastomosis of the two limbs of the fundal wrap. The maintenance of the wrap then relies on healing and physical union of the stomach wall, rather than on sutures that eventually cut out, leading to recurrence of reflux. The procedure has been performed in four neurologically impaired children, in three after failure of a previous Nissen procedure. There has been one complication, an adhesive bowel obstruction, and follow-up is too short to assess the ultimate results.