Laparoscopic fundoplication after previous open abdominal operations in infants and children

There have been multiple reports in the adult literature stating that previous open operations should no longer be considered a contraindication to the laparoscopic approach. However, there are little data on this topic in the pediatric population, particularly in patients with neonatal abdominal pathology unique to the newborn population. Therefore, we reviewed our experience with laparoscopic fundoplication after a variety of previous abdominal conditions and operations in the pediatric population.

An institutional review board-approved retrospective chart review was performed on all patients undergoing laparoscopic fundoplication after a previous open operation between October 2000 and December 2007. The data collected demographics, comorbid conditions, previous abdominal operations, gastrostomy tube placement, time interval between the initial operation and laparoscopic fundoplication, conversions, and complications.

Forty-five patients underwent a laparoscopic Nissen fundoplication after an open operation during the study interval. Mean age was 41.3 months (range, 1-233) with a mean weight of 14.3 kg (range, 2.9-63.6), and 31 were (78.9%) male. A total of 61 previous abdominal operations were performed (range, 1-4). Mean time between last open operation and laparoscopic fundoplication was 27.3 months (range, 0.5-147). Mean operative time was 161 minutes (range, 73-420). There were no conversions and 3 perioperative complications occurred (splenic hematoma, clogged gastrostomy tube, and liver bleed). Early reoperations were performed in 2 patients (4.4%): 1 for bleeding on day 2 and the other for leaking gastrostomy day 12.

Our data demonstrate that laparoscopic fundoplication after a previous open operation is feasible and safe.