Laparoscopic "TOUSSEN" fundoplication for pediatric gastroesophageal reflux disease: a new modified technique gentle...

Existing fundoplication techniques, although effective, may present drawbacks as dysphagia and recurrence. This study presents a new modified Laparoscopic Toussen (TOUpet-niSSEN) Fundoplication (LTF) developed to reduce the risk of dysphagia and recurrence. We aim to report its safety, feasibility and efficacy in the treatment of pediatric Gastroesophageal Reflux Disease (GERD).

A retrospective study was performed on the clinical data, surgical procedures, and follow-up of a cohort of consecutive patients who received LTF at our tertiary center from 2010 to 2023. The LTF combines a 270° Toupet valve at the upper section and a 360° Nissen valve at the lower section. The exclusion criteria encompassed age over 18 years and patients referred for a redo fundoplication. The diagnosis was based on symptoms and radiological/additional exams, corroborated by a multidisciplinary meeting.

Over a span of 13 years, we treated 219 patients (average of 16 LTF each year), including 49 (22%) with neurological impairment and 13 (6%) with esophageal atresia. The median age at surgery was 5.5 years (range: 1.1-17.5 years), and the median weight 18.2 kg (range: 5.5-80 kg). Gastrostomy was performed in 33 instances (15%). The median duration was 70 min (range: 44 to 177 min). No patient required conversion to laparotomy. Intraoperative problems were observed in 0.4% of patients. During the first postoperative month, 13 early complications occurred (6%): 8 dysphagia, 1 bronchopneumonia, 1 removal of the gastrostomy button, 1 bleeding from trocar orifice, 1 umbilical incisional hernia, and 1 self-limiting neurological symptom. The median duration of hospitalization was 2 days (range: 1-45 days). Overall, we monitored 190 patients for at least 6 months, with a median follow-up of 4.5 years (range: 0.6-11 years). Four patients (2%) required additional surgical intervention: two laparoscopic partial valve releases, one redo fundoplication, and one incisional hernia repair.

In this first analysis of the short- and medium-term outcomes, LTF seemed safe and efficacious for the treatment of pediatric GERD.

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