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Laparoscopic watson fundoplication is effective and durable in children with gastrooesophageal reflux
Matthew G Dunckley1, Kapil M Rajwani1, Anies A Mahomed1
1Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Brighton BN2 5BE, UK.
Insights
Laparoscopic Watson fundoplication offers durable gastroesophageal reflux (GER) control in children, including those with neurological impairments. This partial fundoplication technique shows a low complication rate, presenting a safe alternative to traditional Nissen operations.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastroesophageal reflux (GER) is prevalent in children, causing significant morbidity, especially in those with neurological impairments.
- The Nissen fundoplication, a traditional surgical approach for GER, has limitations including mechanical complications and a notable reoperation rate.
- Alternative antireflux procedures are needed, particularly for the pediatric population, due to the Nissen operation's drawbacks.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of laparoscopic Watson fundoplication in pediatric patients.
- To assess the safety and efficacy of this partial fundoplication technique, especially in neurologically impaired children.
- To compare Watson fundoplication as a viable alternative to the Nissen procedure in pediatric surgery.
Main Methods:
- A retrospective analysis of 76 children and infants undergoing laparoscopic Watson fundoplication.
- Inclusion of patients with varying degrees of neurological impairment (34%).
- Assessment of complication rates, including major complications, perforations, and revisions.
Main Results:
- An overall complication rate of 27.6% was observed, with only one major complication.
- No perforations or revisions were recorded during the study period.
- Durable reflux control was achieved with minimal complications in both neurologically impaired and unimpaired children.
Conclusions:
- Laparoscopic Watson fundoplication is a safe and effective procedure for managing gastroesophageal reflux in children.
- The technique demonstrates minimal complications and durable results, making it a suitable alternative to Nissen fundoplication.
- Particularly in neurologically compromised pediatric patients, Watson fundoplication offers a promising antireflux solution.
Abstract:
Gastroesophageal reflux (GOR) affects 2-8% of children over 3 years of age and is associated with significant morbidity. The disorder is particularly critical in neurologically impaired children, who have a high risk of aspiration. Traditionally, the surgical antireflux procedure of choice has been Nissen's operation. However, this technique has a significant incidence of mechanical complications and has a reoperation rate of approximately 7%, leading to the development of alternative approaches. Watson's technique of partial anterior fundoplication has been shown to achieve long-lasting reflux control in adults with few mechanical complications, but there is limited data in the paediatric population. We present here short- and long-term outcomes of laparoscopic Watson fundoplication in a series of 76 children and infants, 34% of whom had a degree of neurological impairment including severe cerebral palsy and hypoxic brain injury. The overall complication rate was 27.6%, of which only 1 was classified as major. To date, we have not recorded any incidences of perforation and no revisions. In our experience, Watson's laparoscopic partial fundoplication can be performed with minimal complications and with durable results, not least in neurologically compromised children, making it a viable alternative to the Nissen procedure in paediatric surgery.
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