Collis–Nissen fundoplication using a computer-powered right angle linear cutting stapler in children

We reviewed our clinical experience of using a computer-powered right angle linear cutter (CPRALC) for Collis–Nissen fundoplication (CNF) in three children with gastroesophageal reflux (GER) or failed Nissen associated with short esophagus. Case 1 was a 13-month-old female with persistent GER after type-C esophageal atresia repair. Case 2 was a 2-year-old female with dysphagia secondary to fundic wrap migration after laparoscopic Nissen. Case 3 was a 3-year-old male with post type-C esophageal atresia repair, dysphagia secondary to fundic wrap migration after open Nissen. All had short esophagus confirmed pre- or intra-operatively. After the esophagus was mobilized, Collis vertical gastroplasty was performed using CPRALC parallel to the lesser curve to elongate the esophagus. Nissen fundoplication was performed loosely around the neo-esophagus. There were no intra- or post-operative complications, although case 3 still has mild dysphagia, requiring dilatation. This is the first report of CNF performed using CPRALC in children. It would appear to be safe and effective for treating children with GER or failed Nissen associated with short esophagus.