Related Experiment Video
Updated: Aug 13, 2026
Technical Considerations and Approach to Redo Foregut Surgery
Published on: September 22, 2023
Fundoplication in paediatric surgery: a survey in 40 German institutions
A I Schmidt1, S Glüer, B M Ure
1Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany. Schmidt.Annika@MH-Hannover.de
Insights
Laparoscopic fundoplication for pediatric GERD is not standard in Germany due to low procedure volumes. However, the technique shows excellent feasibility and low conversion rates, indicating potential for wider adoption in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Innovation
Background:
- Gastroesophageal reflux disease (GERD) lacks a standardized surgical approach.
- Laparoscopic fundoplication is considered a preferred method for pediatric GERD.
- Current standards of care in Germany require assessment.
Purpose of the Study:
- To evaluate diagnostic workup and surgical techniques for GERD in German pediatric surgical institutions.
- To assess the adoption and feasibility of laparoscopic fundoplication in pediatric GERD treatment across Germany.
Main Methods:
- A 14-item questionnaire was distributed to 71 German pediatric surgery departments.
- Forty departments (56%) participated, reporting on diagnostic workup, operative techniques, procedure volume, and conversion rates.
Main Results:
- Most institutions (90%) perform fewer than 20 fundoplications annually.
- Only 60% of institutions have experience with laparoscopic fundoplication, with many performing fewer than 50 cases.
- In 2002, 32% of 584 fundoplications were laparoscopic, with significant variation between academic and non-academic centers. The Nissen wrap was the preferred technique.
Conclusions:
- The laparoscopic approach for pediatric GERD is not yet widely adopted in Germany.
- Limited procedure volume poses challenges for training and standardization.
- Despite adoption challenges, laparoscopic fundoplication demonstrates excellent feasibility and low conversion rates in Germany.
Background:
There is no generally accepted standard surgical approach to gastrooesophageal reflux disease (GERD) at present. However, laparoscopic fundoplication has been advocated to be the procedure of choice for gastrooesophageal reflux disease in children. We aimed to assess the standards of the diagnostic workup and operative techniques in paediatric surgical institutions in Germany.
Material And Methods:
A questionnaire including 14 items was sent to all 71 departments of paediatric surgery in Germany. Forty (56 %) took part in the survey. Concepts of routine diagnostic workup, operative techniques, number of procedures, and conversions were assessed.
Results:
The average annual frequency of fundoplications was less than 20 in 36 units (90 %). Experience with laparoscopic fundoplication was present in 24 institutions (60 %). In 19 out of these (79 %) fewer than 50 laparoscopic fundoplications had been performed altogether up to the time of the survey. Out of 584 fundoplications performed in the year 2002, 184 (32 %) had been done laparoscopically. The ratio of conventional versus laparoscopic fundoplication was 170/130 (57/43 %) in academic, and 226/54 (81/19 %) in non-academic departments. The preferred technique of fundoplication, irrespective of the approach, was the Nissen wrap in 28 (70 %) of the departments. The number of paediatric surgeons performing laparoscopic fundoplication was 1 - 2 in 16 institutions (67 %), 3 or 4 in 6 (25 %), and 5 in 2 (8 %) departments. The conversion rate was reported to be less than 5 % in 15 departments (63 %), and 5 - 10 % in 3 (13 %).
Conclusion:
The laparoscopic approach for surgical repair of GERD in children is not yet generally accepted in Germany. In most departments, training remains problematic due to low numbers of procedures. However, the feasibility of laparoscopic fundoplication in Germany is excellent, with a low rate of conversions.
