Outcome after laparoscopic fundoplication in children under 1 year

Laparoscopic fundoplication has not been extensively reviewed to establish the efficacy and outcome in infants. Our aims were to investigate the outcome of laparoscopic fundoplication in infants and assess factors predicting outcome.

We performed a retrospective study on infants undergoing laparoscopic fundoplication. Demographic data, operating time, length of hospital stay, complications, and need for redo fundoplication were recorded. Chi-squared test was performed to correlate symptoms and outcome. There were 79 patients. Median age was 6 months (range 0.5 to 11) and weight was 5.6 kg (2.6 to 10). Forty-eight were neurologically impaired, 4 had esophageal atresia and tracheo-esophageal fistula.

The most common presenting symptoms were vomiting (71), failure to thrive (63), recurrent aspiration (47), and acute life threatening events (35). Thirty-six had severe, 20 moderate, and 19 mild reflux. Three intraoperative complications occurred: 2 (2.5%) conversions (liver bleed, inability to tolerate pneumoperitoneum) and 1 pneumothorax. Median time to full feeds was 4 days (interquartile range 3 to 6) and discharge 6 days (4 to 16). Thirty-one patients had late complications. Nineteen had retching; 2 had dysphagia-needing dilatation. Sixteen patients (20%) had late mortality due to co-morbidities. Fourteen (18%) needed redo fundoplication. There was no correlation between weight, severity of reflux, presence of either ATLE, or neurological impairment and the incidence of recurrence.

Laparoscopic fundoplication can be safely performed in infants. There was no predictor of recurrence. However, there is a 20% late mortality in patients with severe co-morbidities, which needs to be taken into account when counseling patients.