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Evolution of the modified Rossetti fundoplication in children: surgical technique and results
M S Levy1, C W Sorrels, C W Wagner
1Division of Pediatric Surgery, Arkansas Children's Hospital, Little Rock 72202-3591, USA.
Insights
The modified Rossetti fundoplication is a preferred surgical treatment for pediatric gastroesophageal reflux, showing lower rates of recurrent reflux and shorter operative times compared to the classic Nissen fundoplication.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Classic Nissen fundoplication is the traditional surgical treatment for pediatric gastroesophageal reflux.
- The modified Rossetti fundoplication involves liver retraction, no crural repair, intact short gastric vessels, and a 2-cm floppy wrap.
Purpose of the Study:
- To compare the efficacy and outcomes of modified Rossetti fundoplication versus classic Nissen fundoplication in pediatric patients.
- To evaluate complication rates, operative time, and recurrence of reflux between the two surgical techniques.
Main Methods:
- Retrospective chart review of 407 pediatric patients undergoing open fundoplication between January 1993 and February 1998.
- Analysis of two groups: Nissen fundoplication (171 patients) and modified Rossetti fundoplication (236 patients).
- Comparison of outcomes including recurrent reflux, dysphagia, hiatal hernia, need for dilation, revision rates, and operative time.
Main Results:
- Dysphagia, hiatal hernia, need for dilation, and revision rates were similar between the Rossetti and Nissen groups.
- Mean operative time was significantly reduced in the Rossetti group (65 minutes) compared to the Nissen group (73 minutes).
- Recurrent reflux occurred significantly less often in the Rossetti group (5.1%) than in the Nissen group (11.2%).
Conclusions:
- The modified Rossetti fundoplication demonstrates a low complication rate in pediatric patients.
- This technique is associated with a lower incidence of recurrent reflux compared to the classic Nissen procedure.
- The modified Rossetti fundoplication is the preferred surgical method for treating pediatric gastroesophageal reflux by the authors.
Objective:
To compare the modified Rossetti fundoplication with the classic Nissen.
Summary Background Data:
The traditional surgical treatment of gastroesophageal reflux in children has been the classic Nissen fundoplication, defined by liver mobilization, crural repair, takedown of short gastric vessels, and floppy wrap. The authors have progressed in our technique of fundoplication and now perform a modified Rossetti fundoplication, defined by liver retraction without mobilization, no crural repair, short gastric vessels left intact, and 2-cm floppy wrap.
Methods:
A retrospective chart review was performed on 407 pediatric patients who had open fundoplications (Jan. 13, 1993, to Feb. 25, 1998). Two groups were analyzed: the Nissen group (171 patients) and the Rossetti group (236 patients). Groups were compared for incidence of recurrent reflux, dysphagia, hiatal hernia, need for esophageal dilation, revision of fundoplication, time to discharge, and operative time.
Results:
Incidence of dysphagia (3.7% vs. 3.3%), postoperative hiatal hernia (1.9% vs. 1.4%), need for esophageal dilation (1.2% vs. 0.5%), and need for fundoplication revision (2.5% vs. 2.3%) were similar between the groups. The mean operative time was significantly decreased in the Rossetti group (65 +/- 25 minutes) versus the Nissen group (73 +/- 33 minutes). Recurrent reflux occurred significantly more often in the Nissen group (11.2%) than in the Rossetti group (5.1 %).
Conclusion:
The modified Rossetti fundoplication has a low complication rate and is the authors' preferred method for the surgical treatment of gastroesophageal reflux in children.
