Eversion cruroplasty and collar overwrap: a novel hybrid approach for refractory gastroesophageal reflux disease in children, with assessment of mid-term outcomes.

Background: Surgical fundoplication remains integral in managing gastroesophageal reflux disease (GERD) by addressing gastroesophageal valve incompetence. This study introduces a novel hybrid approach, the Eversion Cruroplasty and Collar Overwrap (ECCO) procedure, aiming to combine benefits of conventional partial wrapping and posteromedial cardiopexy, considering gastric fundus anatomical peculiarities as an anti-reflux barrier.

Methods: A retrospective analysis of pediatric patients presenting with refractory GERD from 2021 to 2023 was conducted. Inclusion criteria focused on primary GERD cases; secondary and redo cases were excluded. Diagnostic modalities included upper gastrointestinal contrast series and endoscopy. Demographic, operative, and postoperative data were assessed.

Results: Among 57 cases, 8 with recurrent hiatal hernia were excluded. Enrolled cases (n = 49) had a mean age of 3.78 years and mean weight of 11.9 kg. All underwent laparoscopic ECCO procedure, with a mean operative time of 87 min. During follow-up, six children experienced transient gas-bloat, and four had temporary dysphagia to solids. Two cases required revisions for absolute failures, while three managed partial recurrences with proton pump inhibitors. Of the total 49 cases, only nine required postoperative endoscopic assessment, which revealed a fully competent cardia with adequate wrapping in four of them. The remaining 40 cases demonstrated clinical improvement with the cessation of PPIs over a mean follow-up period of 11.6 months.

Conclusions: 'Eversion Cruroplasty' preserves crural pillar muscle excursion, avoiding segmentation seen with traditional suturing. The 'Collar Overwrap' achieves a 90% success rate, aligning the GE-junction while maintaining fundic pouch geometry, emphasizing its effectiveness and anatomical fidelity.