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Comparison of long-term outcomes between open and laparoscopic Thal fundoplication in children
Rainer Kubiak1, Elena Böhm-Sturm1, Daniel Svoboda1
1Department of Pediatric Surgery, Mannheim Medical School (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Insights
Long-term outcomes for open and laparoscopic Thal fundoplication in children are similar. While laparoscopic surgery is an alternative, it shows no clear advantage over the open approach for pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic fundoplication is increasingly utilized in pediatric surgery.
- Thal fundoplication is a common surgical procedure for gastroesophageal reflux disease in children.
Purpose of the Study:
- To compare the long-term outcomes of open versus laparoscopic Thal fundoplication in pediatric patients.
- Evaluate the efficacy and safety of both surgical approaches in children.
Main Methods:
- Retrospective study of 101 children undergoing Thal fundoplication (open: 47, laparoscopic: 54) between 1997 and 2009.
- Minimum follow-up of 2 years; median follow-up of 77 months.
- Comparison of intraoperative issues, postoperative complications, feeding times, hospital stay, and long-term results.
Main Results:
- No significant differences in early complications, feeding, or length of stay between open and laparoscopic groups.
- Open surgery was shorter (108 min vs. 144 min), particularly in neurologically impaired children.
- Redo-fundoplication was required in 11.9% of patients (6 in each group); severe dysphagia occurred in 10 patients (not significantly different).
- Overall surgical results (excellent, good, satisfactory) were similar, with 79.2% achieving these outcomes.
Conclusions:
- Both open and laparoscopic Thal fundoplication demonstrate comparable long-term outcomes in children.
- The laparoscopic approach is a viable alternative, but does not offer a clear superiority over the open method.
- Surgical approach choice may depend on patient-specific factors, especially in neurologically compromised pediatric patients.
Objectives:
In recent years laparoscopic fundoplication is increasingly performed in pediatric surgery. The aim of this study was to compare the long-term outcomes between open and laparoscopic Thal fundoplication in children.
Methods:
This retrospective study includes children who underwent a Thal fundoplication between 3/1997 and 7/2009. The minimum follow-up time to enter the study was 2 years; the overall median follow-up was 77 months (range, 29-176 months).
Results:
A total of 101 patients were included, of which 47 underwent an open and 54 a laparoscopic Thal. Intraoperative problems, early postoperative complications, time to establish enteral feeds and length of stay did not differ among both groups. The mean duration of surgery was significantly less in the open group (OPG) (108.0 (± 7.72) versus 144.1 (± 6.36) minutes; p=0.001) and this was mainly attributed to patients with neurological problems. Severe dysphagia requiring endoscopy was observed in 10 patients, but this did not differ significantly between groups (n=2 in the OPG vs. n=8 in the laparoscopic group (LAPG); p=0.10). Overall 12 patients (11.9%) (6 in each group) required a redo-fundoplication after a median of 18.7 months (range, 6-36 months). In the whole study group, 80 patients (79.2%) were classified as having surgical results being excellent, good or satisfactory and this did not differ significantly between groups.
Conclusions:
In the long-term open and laparoscopic Thal fundoplication have similarly good outcomes. The laparoscopic approach can be considered as an alternative, however there is not a clear superiority compared with the open counterpart.
