Effective Nissen fundoplication length and bougie diameter size in young children undergoing laparoscopic Nissen...

Laparoscopic Nissen fundoplication (LNF) is utilized in the management of symptomatic gastroesophageal reflux disease (GERD) in children. An effective length of fundoplication and bougie size has never been established in infants and children requiring LNF for GERD. To determine this effective fundoplication length and appropriate bougie size, we analyzed all patients less than 15 kg undergoing LNF for GERD over a 2-year period.

Data recovered retrospectively included age, weight, gender, need for gastrostomy, length of postoperative hospitalization, operating time, bougie size, and fundoplication length.

One hundred patients weighed less than 15 kg (mean, 7.23 kg). Mean operating time was 95 minutes (range, 31 minutes to 159 minutes). Gastrostomies were placed in 32 patients. Postoperative hospitalization averaged 1.8 days for elective LNF. Fundoplication length was measured in each patient and averaged 2.06 cm. Bougie size varied from 22F to 42F, and the size utilized was based on the patient's weight. There were no instances of dysphagia or the need for esophageal dilatation postoperatively. Two patients have been seen for recurrent symptoms. One patient has required a second LNF, and the other has a normal upper gastrointestinal study and pH study.

This study of LNF in small children has shown that resolution of GERD symptoms in most patients can be accomplished with an average fundoplication length of approximately 2 cm and a graduated bougie size relative to the patient's weight.