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Published on: February 28, 2025
[Laparoscopic surgery of gastroesophageal reflux in children]
Ana Dias1, Marina Amaral2, Eunice Trindade3
1Faculdade de Medicina. Universidade do Porto. Porto. Portugal.
Insights
Laparoscopic Nissen fundoplication is a safe and effective surgical option for pediatric gastroesophageal reflux disease, even in infants. This minimally invasive approach shows good outcomes with low complication rates.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastroesophageal reflux is common in children, but gastroesophageal reflux disease may require surgical intervention.
- Laparoscopic antireflux surgery, specifically Nissen fundoplication, is an option for severe cases.
- Infants with gastroesophageal reflux disease present unique surgical considerations.
Purpose of the Study:
- To evaluate the feasibility, effectiveness, and safety of laparoscopic Nissen fundoplication in children.
- To specifically assess outcomes in infants undergoing the procedure.
- To analyze the impact of age and comorbidities on surgical outcomes.
Main Methods:
- A retrospective study of 55 children undergoing laparoscopic antireflux surgery between 2006 and 2012.
- Patients were categorized into three age groups: <1 year, 1-3 years, and >3 years.
- Data collected included demographics, symptoms, comorbidities, operative details, and postoperative outcomes.
Main Results:
- Laparoscopic Nissen fundoplication was successfully performed in 94.5% of cases.
- The mean operative time was 167 minutes, with no significant age-related differences.
- Complications included gas-bloat syndrome, dumping, or dysphagia (15.7%) and paraesophageal hernia (3.9%), with low recurrence rates.
Conclusions:
- Laparoscopic Nissen fundoplication is a feasible and effective treatment for pediatric gastroesophageal reflux disease.
- The procedure demonstrates minimal morbidity, including in the infant population.
- This minimally invasive approach offers a safe alternative to open surgery.
Introduction:
Gastroesophageal reflux is a common but usually innocuous condition in children. However, in the presence of Gastroesophageal reflux disease, the surgical treatment (open or laparoscopic) may be indicated. This study aimed to evaluate the feasibility, effectiveness and safety of laparoscopic antireflux surgery (Nissen fundoplication) with emphasis in infants.
Material And Methods:
Children with gastroesophageal reflux proposed for laparoscopic antireflux surgery between January 2006 and December 2012 in a pediatric surgery department of a university hospital were studied. A descriptive and comparative analysis was conducted with regard to age (group I: <1 year, group II: 1-3 years, group III: > 3 years) and presence of comorbidities. Demographics, symptoms, comorbidities, operative indications, perioperative and postoperative outcome were assessed. The statistical significance level was set at 5%.
Results:
55 children were proposed for surgery: 12 of group I, 15 group of II and 28 of group III. 50.9% had comorbidities (21 central nervous system disease and 7 esophageal atresia). In 52 (94.5%) cases, antireflux surgery was performed by laparoscopy. The procedure lasted 167 ± 42 minutes, with no significant differences according to age groups, although higher in those with central nervous system disease. With a follow-up of 35.5 ± 23.9 months, the following complications occurred: gas-bloat syndrome, dumping or dysphagia in 8 cases (15.7%) and paraesophageal hernia in 2 cases (3.9%), with no significant differences between groups; there was clinical recurrence with reoperation in 2 cases.
Conclusion:
Laparoscopic Nissen fundoplication is a feasible and effective procedure, with minimal morbidity, including in infancy.
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