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Laparoscopic Toupet's fundoplication in children.

Philippe Montupet¹

¹Pediatric Surgery Unit, Bicetre Hospital, Paris, France. philippe.montupet@wanadoo.fr

Seminars in Laparoscopic Surgery

|October 31, 2002

Summary

Toupet fundoplication, a 270-degree posterior valve, is effective for pediatric gastroesophageal reflux disease (GERD) refractory to medication. This surgical approach shows a low recurrence rate in long-term follow-up studies.

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Area of Science:

Pediatric Surgery
Gastroenterology
Surgical Innovation

Background:

Gastroesophageal reflux disease (GERD) in children often requires surgical intervention when medical management fails.
Laparoscopic fundoplication is considered the gold standard for refractory pediatric GERD.
The Toupet procedure, a posterior partial fundoplication, is a commonly employed surgical technique.

Purpose of the Study:

To evaluate the single-surgeon experience with the Toupet fundoplication in pediatric patients.
To assess the efficacy and complication rates of the 270-degree posterior valve in treating pediatric GERD.
To determine the long-term recurrence rate of GERD following laparoscopic Toupet fundoplication.

Main Methods:

A retrospective review of 574 pediatric patients who underwent Toupet fundoplication by a single surgeon between May 1993 and May 2002.
Analysis of surgical duration, intraoperative complications, and postoperative outcomes, including GERD recurrence.
Specific attention was given to outcomes in infants (<1 year) and neurologically impaired children.

Main Results:

The average surgical duration was approximately 1 hour.
Complications were minimal, with only 3 cases of omental evisceration through port sites.
A low rate of GERD recurrence (6 patients) was observed, with successful reoperation in all cases.

Conclusions:

The 270-degree posterior Toupet fundoplication is a safe and effective procedure for pediatric GERD.
This technique demonstrates a low rate of recurrence, even in challenging patient populations like infants and neurologically impaired children.
Laparoscopic Toupet fundoplication offers favorable long-term outcomes for refractory pediatric GERD.

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