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Thirty-day outcome in children randomized to open and laparoscopic Nissen fundoplication
Charlotte K Knatten1, Thomas J Fyhn, Bjørn Edwin
1Faculty of Medicine, University of Oslo, 0316 Oslo, Norway. charlotte@knatten.org
Insights
Laparoscopic Nissen fundoplication (LNF) did not prove superior to open Nissen fundoplication (ONF) in early results for pediatric gastroesophageal reflux disease. Surgery duration was longer with LNF, but hospital stay and complication rates were similar between the two surgical approaches.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention.
- Laparoscopic Nissen fundoplication (LNF) is increasingly adopted, with some suggesting its superiority over open Nissen fundoplocation (ONF).
- A randomized trial was conducted to compare the early outcomes of LNF and ONF in pediatric patients.
Purpose of the Study:
- To compare the early results of laparoscopic Nissen fundoplication (LNF) versus open Nissen fundoplication (ONF) in children.
- To evaluate differences in surgery duration, length of hospital stay, and postoperative complications.
- To determine if LNF offers an advantage over ONF in the initial postoperative period.
Main Methods:
- A randomized trial involving children undergoing antireflux surgery for GERD.
- Standardized anesthesia, surgical techniques, and postoperative care were applied.
- Data collected included patient demographics, length of hospital stay (LOS), and complications within 30 days post-surgery.
Main Results:
- Eighty-eight children were randomized: 44 to LNF and 44 to ONF. Groups were comparable in age, weight, and comorbidity.
- LNF surgery duration averaged 150 minutes, significantly longer than ONF at 89 minutes (P < .001).
- Median LOS was 7.0 days for LNF and 7.5 days for ONF (P = .74). Complication rates and readmissions were similar between groups.
Conclusions:
- This study did not demonstrate the superiority of LNF over ONF based on surgery duration, LOS, and early postoperative complications.
- The outcomes for LNF and ONF were surprisingly similar, with the exception of longer operative times for LNF.
- Further research may be needed to identify specific patient populations or long-term outcomes where LNF might offer advantages.
Background:
Laparoscopic Nissen fundoplication (LNF) is considered by some to be superior to open Nissen fundoplication (ONF). To test this hypothesis, we compared early results after LNF and ONF in a randomized trial.
Methods:
All children accepted for antireflux surgery for gastroesophageal reflux disease were offered enrollment. Ethical approval and parental consent were obtained. Anesthesia, surgical methods, and postoperative treatment were standardized. Patient demographics, length of hospital stay (LOS), and complications occurring the first 30 postoperative days were registered.
Results:
Eighty-eight children were randomized to LNF (n = 44) or ONF (n = 44). The groups were comparable with regard to age, weight, and comorbidity. Duration of surgery was 150 ± 34 minutes for LNF and 89 ± 25 minutes for ONF (P < .001). Median LOS was 7.0 days (range, 3-57 days) and 7.5 days (range, 2-20 days) after LNF and ONF, respectively (P = .74). Postoperative complications occurred in 48 patients, 24 in both groups. Twenty-four patients (LNF: n = 12, ONF: n = 11) were readmitted to hospital because of complications occurring after discharge.
Conclusions:
This study failed to show that LNF is superior to ONF when surgery duration, LOS, and complications occurring during the first postoperative month were compared. Apart from surgery duration, the results were surprisingly similar.
