{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T06:15:56Z","timestamp":1782368156137,"version":"3.54.5"},"reference-count":22,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T00:00:00Z","timestamp":1677024000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Med Chir"],"abstract":"<jats:p>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.\n52 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\u2019s 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.\n\u00a0<\/jats:p>","DOI":"10.4081\/pmc.2023.310","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T14:38:20Z","timestamp":1677076700000},"source":"Crossref","is-referenced-by-count":2,"title":["GERD surgery in non-neurologic patients: Modified Laparoscopic Hill-Snow Repair is a valid alternative to Nissen fundoplication. Results of a 20 years of follow-up"],"prefix":"10.4081","volume":"45","author":[{"given":"Salvatore Fabio","family":"Chiarenza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2830-9400","authenticated-orcid":false,"given":"Lorenzo","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa","family":"Conighi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Zolpi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorella","family":"Fasoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3380-7145","authenticated-orcid":false,"given":"Giulia","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"La Pergola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8808-076X","authenticated-orcid":false,"given":"Cosimo","family":"Bleve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"1784","doi-asserted-by":"crossref","unstructured":"Maish M, Hagen JA. Laparoscopic fundoplication. Operative Techniq Thoracic Cardiovasc Surg 2004;9:115-128","DOI":"10.1053\/j.optechstcvs.2004.05.003"},{"key":"1785","doi-asserted-by":"crossref","unstructured":"Rothenberg SS. Two decades of experience with laparoscopic Nissen fundoplication in infants and children: a critical evaluation of indications, technique, and results. J Laparoendosc Adv Surg Tech A 2013;23:791\u20134.","DOI":"10.1089\/lap.2013.0299"},{"key":"1786","doi-asserted-by":"crossref","unstructured":"Mauritz FA, Conchillo JM, van Heurn LW, et al. Effects and efficacy of laparoscopic fundoplication in children with GERD: a prospective, multicenter study. Surg Endosc 2017;31:1101-1110.","DOI":"10.1007\/s00464-016-5070-z"},{"key":"1787","doi-asserted-by":"crossref","unstructured":"Hill LD. An effective operation for hiatal hernia: An eight-year appraisal. 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Acad\u00e9mie De Chirurgie 1963;89:394\u20139."},{"key":"1796","doi-asserted-by":"crossref","unstructured":"Park Y, Aye RW, Watkins JR, et al. Laparoscopic Hill repair: 25-year follow-up. Surg Endosc 2018;32:4111-4115.","DOI":"10.1007\/s00464-018-6150-z"},{"key":"1797","doi-asserted-by":"crossref","unstructured":"Aye RW, Swanstrom LL, Kapur S, et al. A randomized multiinstitution comparison of the laparoscopic Nissen and Hill repairs. Ann Thorac Surg 2012;94:951-7.","DOI":"10.1016\/j.athoracsur.2012.04.083"},{"key":"1798","doi-asserted-by":"crossref","unstructured":"Schneider AM, Aye RW, Wilshire CL, et al. Tri-comparison of laparoscopic Nissen, Hill, and Nissen-Hill hybrid repairs for uncomplicated gastroesophageal reflux disease. J Gastrointest Surg 2017;21:434-440.","DOI":"10.1007\/s11605-016-3317-6"},{"key":"1799","doi-asserted-by":"crossref","unstructured":"Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018;66:516-554.","DOI":"10.1097\/MPG.0000000000001889"},{"key":"1800","doi-asserted-by":"crossref","unstructured":"Kubiak R, Andews J, Grant HW. Long term outcome of laparoscopic Nissen fundoplication compared with laparoscopic Thal fundoplication in children: a prospective, randomized study. Ann Surg 2011;253:44-49.","DOI":"10.1097\/SLA.0b013e3181fc98a0"},{"key":"1801","doi-asserted-by":"crossref","unstructured":"Soyer T, Yal\u00e7\u0131n S, Demir N, et al. Does Nissen fundoplication improve deglutition in children? Turkish J Pediatr 2017;59:28-34.","DOI":"10.24953\/turkjped.2017.01.005"},{"key":"1802","doi-asserted-by":"crossref","unstructured":"Wills VL, Hunt DR. Dysphagia after antireflux surgery. 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Br J Surg 1994;81:548-550.","DOI":"10.1002\/bjs.1800810421"}],"container-title":["La Pediatria Medica e Chirurgica"],"original-title":[],"link":[{"URL":"https:\/\/www.pediatrmedchir.org\/pmc\/article\/download\/310\/336","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pediatrmedchir.org\/pmc\/article\/download\/310\/336","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T14:38:29Z","timestamp":1677076709000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pediatrmedchir.org\/pmc\/article\/view\/310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,22]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,2,22]]}},"URL":"https:\/\/doi.org\/10.4081\/pmc.2023.310","relation":{},"ISSN":["2420-7748","0391-5387"],"issn-type":[{"value":"2420-7748","type":"electronic"},{"value":"0391-5387","type":"print"}],"subject":[],"published":{"date-parts":[[2023,2,22]]}}}