Laparoscopic refundoplication in children

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery

Background:

• Gastroesophageal fundoplication is a common pediatric surgery, with laparoscopic approaches significantly increasing its prevalence.
• Laparoscopic fundoplication, despite its minimally invasive nature, is associated with substantial morbidity.
• This study evaluates the outcomes of laparoscopic refundoplication in pediatric patients.

Observation:

• Four children underwent laparoscopic refundoplication after a prior Thal procedure due to recurrent symptoms.
• Two children had recurrent symptoms despite normal pH studies.
• Surgical complexity varied, with one case requiring conversion and another complicated by a large hiatal hernia.

Findings:

• Laparoscopic refundoplication involved converting the Thal procedure to Nissen or Toupet fundoplications in three children.
• One child with an intrathoracic wrap and hiatal hernia underwent repair with a Goretex patch and redo-Thal.
• All children were symptom-free from pathologic gastroesophageal reflux within 2 to 4 years of follow-up, with no recurrence.

Implications:

• Laparoscopic refundoplication is a viable and safe option for managing recurrent gastroesophageal reflux in children previously treated with laparoscopic fundoplication.
• This technique does not appear to increase the morbidity associated with initial antireflux surgery.
• Further research may explore long-term outcomes and patient selection criteria for this procedure.