Management with wrap disruption after Nissen fundoplication in a child with gastro-oesophageal reflux after congenital oesophageal atresia: A case report and minireview

Pathological gastro-oesophageal reflux (GER) is one of the most common complications that results in the aftermath of treatment of congenital oesophageal atresia (EA). The aim of this study is to present a case of a 7-year-old girl with severe gastro-oesophageal reflux disease (GERD) operated on in the neonatal period due to EA with a lower tracheo-oesophageal fistula (TEF). The patient, despite the use of adequate conservative treatment, clinically and in the endoscopic examination was diagnosed with severe oesophagitis (LA-D in the Los Angeles classification). After a laparoscopic fundoplication by the Nissen method at the age of 4, a transient clinical improvement and a reduction of inflammatory lesions in the oesophagus were obtained. Three years after the procedure, the patient presented with deterioration of GERD clinical symptoms in the form of: regularly occurring vomiting with periodic admixture of fresh blood, recurrent cough, symptoms of dysphagia and failure to thrive. An upper gastrointestinal endoscopy (upper GI endoscopy) revealed significant progression of inflammatory changes in the oesophagus and the two-level oesophageal stricture together with endoscopic signs of wrap disruption. Based on the conducted diagnostics, the girl was qualified for surgical revision. The diagnosis was confirmed intraoperatively. During the 4-month postoperative period, a significant clinical improvement and resolution of symptoms were observed. The presented case indicates the need for close and long-term monitoring of patients after EA. In the case of a recurrent reflux oesophagitis in patients after anti-reflux surgery, the possibility of prolonged complications, such as a wrap disruption, herniation or slippage should be taken into consideration.