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BOB Ped Surg 2023 - Mohamad Qinawy, PAPSA - Presentation

Video Published 2023-02-06 Updated 2023-02-13

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Topic Overview

Prospective randomized study comparing laparoscopic Nissen fundoplication versus Thal procedure for pediatric GERD (n=40, 2018-2020). Thal procedure showed significantly less postoperative bloating and dysphagia with faster return to normal eating, though operative time was longer and early learning curve affected recurrence rates.

Key Takeaways

  • Nissen fundoplication remains gold standard for pediatric GERD but post-op bloating (55% in this study) drives search for alternatives
  • Thal procedure showed significantly less bloating (0% vs 55%) and dysphagia (10% vs 35%) compared to Nissen in 40-patient RCT
  • Thal technique: fix distal esophagus intra-abdominally, create angle of His by suturing fundus to esophagus with running non-absorbable suture
  • Early Thal cases had higher recurrence (3/20) attributed to learning curve; technique requires hiatal closure and air-leak testing
  • Thal offers faster return to normal eating with less gas-bloat syndrome but needs larger studies for long-term validation

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