Age-stratified outcomes of laparoscopic hiatal hernia repair with Nissen fundoplication in children: a single-center experience

Abstract Purpose To evaluate outcomes of laparoscopic hiatal hernia repair with Nissen fundoplication in children, comparing infants (≤ 12 months) and older children (> 12 months). Methods Pediatric patients who underwent laparoscopic hiatal hernia repair with Nissen fundoplication between 2008 and 2025 were retrospectively reviewed. Patients were classified by age at surgery into ≤ 12 months and > 12 months. Outcomes included postoperative complications, recurrence, length of hospital stay, and follow-up. Results Nineteen patients were included in this study (10 boys, 9 girls); of which 9 were ≤ 12 months and the remaining 10 were > 12 months. Age-stratified postoperative outcome comparisons were performed in 17 patients after exclusion of 2 patients (%10.5) with concomitant gastrostomy. Median age at repair was 20 months (IQR 5–58.5; 5 days–120 months) and median weight was 9.8 kg (IQR 5.1–17.5; 2.4–50.0 kg). Median length of stay was 4 days (IQR 3–5; 2–7 days), and median follow-up was 84 months (IQR 38.5–112; 4–205 months). Selective mesh reinforcement was used in 3 patients (15.8%) with wide hiatal defects and/or poor crural tissue quality. Postoperative complications occurred in 4 patients (21.1%). Recurrence occurred in 3 patients (15.8%) at 2, 4, and 9 months postoperatively. All underwent redo laparoscopic repair, and no further recurrence was observed during follow-up. Conclusion Laparoscopic hiatal hernia repair with Nissen fundoplication appeared feasible in selected pediatric patients, including infants ≤ 12 months. In this small single-center cohort, recurrences occurred within the first postoperative year and were managed with redo laparoscopy. These findings should be interpreted cautiously and require confirmation in larger multicenter studies.