Laparoscopic redo Nissen fundoplication in infants and children

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Recurrent gastroesophageal reflux disease (GERD) following initial fundoplication presents a surgical challenge.
• Redo fundoplication is necessary for patients experiencing persistent or recurrent symptoms.
• Laparoscopic approaches are increasingly favored for redo anti-reflux procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic redo Nissen fundoplication in pediatric patients with recurrent GERD.
• To compare outcomes of laparoscopic redo fundoplication with historical data for open redo procedures.
• To assess the short-term and early long-term outcomes of this minimally invasive redo surgery.

Main Methods:

• A retrospective review of 118 pediatric patients undergoing laparoscopic redo Nissen fundoplication between 1994 and 2004.
• Patients had a history of primary open or laparoscopic fundoplication.
• Data collected included operative time, complication rates, hospital stay, and wrap failure rates.

Main Results:

• Successful laparoscopic completion in all 118 patients.
• Low intraoperative (1.1%) and postoperative (3.6%) complication rates.
• Short average hospital stay (2.2 days) and time to full feeding (1.8 days).
• A low wrap failure rate of 6% over a mean follow-up of 48 months.

Conclusions:

• Laparoscopic redo Nissen fundoplication is a safe and effective treatment for recurrent GERD in pediatric patients.
• It offers benefits similar to primary laparoscopic Nissen fundoplication, including low morbidity and rapid recovery.
• Early outcomes suggest superior long-term results compared to open redo fundoplication.