Related Experiment Videos
Laparoscopic Toupet's fundoplication in children
1Pediatric Surgery Unit, Bicetre Hospital, Paris, France. philippe.montupet@wanadoo.fr
Insights
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.
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.
Abstract:
Laparoscopic fundoplication is performed commonly in children, and it represents "the gold standard" in children with gastroesophageal reflux disease (GERD) refractory to medical therapy. We present a single surgeon's experience with a posterior partial valve. Between May 1993 and May 2002, we operated on 574 children using Toupet's procedure. Among the patients, 24 were younger than 1 year of age, and 17 others were neurologically impaired. The average duration of the surgery was 1 hour. Complications were limited to 3 eviscerations of omentum through the port wounds. Relapse of GERD secondary to valve failure occurred in 6 patients, 1 neurologically impaired and 1 with mucoviscidosis. All six patients have been reoperated on laparoscopically, and Toupet fundoplication was performed again with good results. We think that the 270-degree posterior valve, according to Toupet, is a good procedure to adopt in children with GERD with a low rate of recurrence at long-term follow-up.