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Laparoscopic fundoplication in children with previous abdominal surgery.

D C Liu1, G J Flattmann, M T Karam

  • 1Children's Hospital of New Orleans, LA 70118, USA.

Journal of Pediatric Surgery
|February 29, 2000
PubMed
Summary

Laparoscopic Nissen fundoplication is safe and effective in children with prior abdominal surgeries, including gastrostomy tubes or VP shunts. This antireflux procedure shows excellent outcomes with minimal complications in this patient group.

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Minimally Invasive Surgery

Background:

  • Gastroesophageal reflux disease (GERD) is common in children, often necessitating antireflux surgery.
  • A significant subset of these children have undergone prior abdominal surgeries, such as gastrostomy tube placement or ventriculoperitoneal (VP) shunts.
  • The impact of previous abdominal surgeries on the outcomes of antireflux procedures is a critical consideration.

Purpose of the Study:

  • To evaluate the safety and efficacy of laparoscopic Nissen fundoplication (LNF) in children with a history of abdominal surgery.
  • To assess surgical outcomes, including complication rates and the functionality of pre-existing devices (gastrostomies, VP shunts).

Main Methods:

  • A retrospective review of 82 consecutive LNF procedures performed between January 1996 and September 1998.

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  • Patients were stratified based on previous abdominal surgery: gastrostomy tube (n=17) or VP shunt (n=11).
  • LNF was performed using a standard 5-port technique, with modifications such as not dividing short gastric vessels (Rosetti modification).

    • Main Results:

    • 31.7% (26/82) of patients had prior abdominal surgery.
    • LNF was successfully completed in 96.2% (25/26) of patients with previous abdominal surgery.
    • No cases of recurrent reflux were reported, and all gastrostomies and VP shunts remained functional post-LNF, with minimal morbidity observed.

    Conclusions:

    • Laparoscopic Nissen fundoplication is a viable and safe surgical option for children with GERD and a history of abdominal surgery.
    • The presence of gastrostomies or VP shunts does not preclude successful LNF with excellent functional outcomes.
    • This approach offers a minimally invasive solution with low morbidity for a complex pediatric surgical population.