Journal of Gastrointestinal Surgery

, Volume 23, Issue 12, pp 2338–2345 | Cite as

Boix-Ochoa (Partial Fundoplication) Treats Reflux, Even in Neurologically Impaired Patients. Can it Take the Title of “Gold Standard” from Total Fundoplication?

  • Hasan Özkan GezerEmail author
  • Semire Serin Ezer
  • Abdulkerim Temiz
  • Emine İnce
  • Akgün Hiçsönmez
Original Article



In 4–5% of cases of gastroesophageal reflux disease (GERD), surgical treatment is required. The aim of the study was to evaluate the success of Boix-Ochoa antireflux surgery, which is considered more physiologic with a higher failure rate (need for reoperation) than Nissen fundoplication, which is believed to be the gold standard operation.


In the 13 years from 2005 to 2018, the medical records of all children who underwent Boix-Ochoa in a single institution by pediatric surgeons were reviewed retrospectively.


A total of 133 fundoplications were performed, of which patients were divided into four groups: neurologically impaired, structurally impaired, neurologically and structurally impaired, and neurologically and structurally normal; there were 64, 8, 34, and 27 patients in each group, respectively. Structural impairments included hiatal hernia and esophagus atresia, having previously had a gastrostomy and esophageal stenosis. The most common short-term complication was distal esophageal stenosis (13%), which caused vomiting and dysphagia, and was treated by dilatations. There were six (4.5%) recurrences of GER, one in the neurologically and structurally impaired group with a hiatal hernia and five in the structurally impaired group (three esophagus atresias, two caustic esophageal strictures). The mean follow-up period was 5.27 ± 3.43 years. Neurological impairment did not affect the success rate.


Although there has not any literature demonstrating significant benefits of one procedure, we detected with this largest study in the pediatric literature about Boix-Ochoa fundoplication (more physiologic and easily performed) that it was successful (95%) in protecting reflux even in neurologically impaired patients (98%). We consider Boix-Ochoa (partial fundoplication) to be an alternative method to Nissen (complete fundoplication), and it can be done safely with a high success rate.


Fundoplication Children Gastroesophageal reflux disease Boix-Ochoa Partial fundoplication 



- Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work;

- Drafting the work or revising it critically for important intellectual content;

- Final approval of the version to be published; and

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

All authors meet all the four criteria mentioned above.

Compliance with Ethical Standards

The data review and collection were performed in compliance with the principles of the ethics committee and the Declaration of Helsinki. This study was approved by the Başkent University Ethical Committee.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryBaşkent University Faculty of MedicineAdanaTurkey

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