Related Experiment Video
Updated: Mar 30, 2026
Utilizing a 3D Printed Laparoscopic Nissen Fundoplication Model to Shorten a Resident's Learning Curve
Published on: August 15, 2025
Laparoscopic Nissen fundoplication in infants with hypoplastic left heart syndrome
Brian T Craig1, Eric J Rellinger1, Bret A Mettler2
1Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Laparoscopic fundoplication is a relatively safe option for hypoplastic left heart syndrome (HLHS) patients during the interstage period, despite a high rate of hemodynamic instability. Outcomes were comparable to open procedures in this high-risk group.
Area of Science:
- Pediatric Surgery
- Cardiovascular Surgery
- Gastroenterology
Background:
- Hypoplastic left heart syndrome (HLHS) patients face increased risks from gastroesophageal reflux, often requiring fundoplication.
- The interstage period (between Stage I and II palliation) poses significant operative risks for HLHS patients due to their unique circulatory physiology.
Purpose of the Study:
- To evaluate the safety and perioperative physiologic impact of laparoscopic fundoplication in HLHS patients during the interstage period.
- To compare the outcomes of laparoscopic versus open fundoplication in this vulnerable patient population.
Main Methods:
- Retrospective review of HLHS patients undergoing open or laparoscopic fundoplication between 2006 and the present.
- Collection and analysis of perioperative hemodynamic data, echocardiographic findings, survival rates, and complications.
Main Results:
- Thirteen of nineteen HLHS patients underwent laparoscopic fundoplication during the interstage period.
- Perioperative hemodynamic instability occurred in 77% of interstage laparoscopic cases, with no significant difference compared to the open approach.
- One laparoscopic patient required ECMO support due to shunt thrombosis.
Conclusions:
- Laparoscopic fundoplication in interstage HLHS patients, while associated with high rates of hemodynamic instability, demonstrates outcomes consistent with existing literature.
- The laparoscopic approach appears to be a relatively safe surgical option for managing gastroesophageal reflux in this high-risk pediatric population.
Background/Purpose:
Patients with hypoplastic left heart syndrome (HLHS) experience a higher risk for complications from gastroesophageal reflux, prompting frequent need for fundoplication. Patients between stage I and II palliation ("interstage") are at particularly high operative risk because of the parallel nature of their pulmonary and systemic blood flow. Laparoscopic approach for fundoplication is common for pediatric patients. However, its safety in interstage HLHS is relatively unknown. We examined the perioperative physiologic burden of a laparoscopic fundoplication in HLHS patients.
Methods:
All patients who underwent open or laparoscopic fundoplication during the interstage period at our institution since 2006 were reviewed. Perioperative physiologic data, echocardiographic findings, survival, and complications were collected from the anesthetic record and patient chart.
Results:
Nineteen patients with HLHS had laparoscopic fundoplication, 13 (68%) during the interstage period, compared to 64 performed by the open approach. Ten (77%) of 13 interstage patients had perioperative hemodynamic instability. Incidence of instability between open and laparoscopic groups was not different. One laparoscopic patient required ECMO support for shunt thrombosis.
Conclusions:
Despite a high incidence of hemodynamic instability, overall outcomes are consistent with those reported in the literature for this high-risk patient population. Laparoscopic approach for fundoplication during the interstage period appears to be a relatively safe option for these patients.
