Related Experiment Video
Updated: Sep 28, 2026
Technical Considerations and Approach to Redo Foregut Surgery
Published on: September 22, 2023
Results of laparoscopic antireflux procedures in neurologically normal infants and children
1University of Birmingham, Birmingham, AL, USA.
Insights
Laparoscopic Nissen fundoplication is a safe and effective surgical treatment for gastroesophageal reflux in neurologically normal children. This procedure offers low recurrence rates when performed with specific technical considerations.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) is common in neurologically impaired children.
- Increasing use of laparoscopic surgery leads to more neurologically normal children undergoing fundoplication for GER.
- Medical management is often insufficient for severe GER.
Purpose of the Study:
- To review the presentation, diagnostic workup, and surgical therapy for pediatric GER unresponsive to medical management.
- To highlight the laparoscopic Nissen fundoplication as the standard surgical approach.
- To detail the technique and outcomes for this procedure in children.
Main Methods:
- Review of presentation, diagnosis, and surgical management of pediatric GER.
- Focus on laparoscopic Nissen fundoplication technique.
- Emphasis on achieving adequate intra-abdominal esophagus length and appropriate fundoplication parameters.
Main Results:
- Laparoscopic Nissen fundoplication is the standard surgical correction for GER in children.
- Key technical aspects include 5-trocar placement, securing 3 cm intra-abdominal esophagus, and loose, 2 cm fundoplication.
- Low recurrence rates observed in neurologically normal children with proper technique and without recurrent gagging/retching.
Conclusions:
- Laparoscopic Nissen fundoplication is a reliable surgical option for pediatric GER.
- Adherence to specific technical details is crucial for successful outcomes.
- Neurologically normal children experience low recurrence rates post-procedure.
Abstract:
Most children treated for gastroesophageal reflux have been neurologically impaired. With the recent growth of laparoscopic surgery, neurologically normal children are being referred for fundoplication. We review the presentation diagnostic workup and surgical therapy for children with gastroesophageal reflux unresponsive to medical management. Although many techniques are available for surgical correction of gastroesophageal reflux in children, the laparoscopic Nissen fundoplication remains the standard for correction of gastroesophageal reflux. The technique is performed through five trocars, and emphasis is placed on obtaining at least 3 cm of intra-abdominal esophagus and holding the esophagus in this position with sutures between the crura and the esophagus. The fundoplication should be loose and no longer than 2 cm in length. Long-term follow-up has shown recurrence to be low in children who are neurologically normal as long as they do not gag and retch recurrently.
