Nissen fundoplication in infants less than 12 months of age: a single-center experience

Antireflux surgery, including fundoplication, can be considered in infants and children with gastroesophageal reflux disease (GERD) and life-threatening complications, refractory to optimal therapy. Only few studies have been performed in infants. We analyse outcomes of Nissen fundoplication (NF) in infants less than 12 months of age affected by GERD in a single-center experience. Retrospective analyse of patients aged from 0 to 12 months who underwent NF at a single paediatric center from January 2014 to June 2020. Follow-up data have been collected until July 2022. Forty-eight patients aged between 0 and 12 months (mean age 6.5 months) underwent NF surgery. The most part of patients (91.7%) was affected by comorbidities. All patients had symptoms of GERD. The weight of 83.3% of patients was below 5th percentile. Surgery was performed with open (27.1%) or laparoscopic approach (72.9%). Three patients (6.3%) had short-term complications requiring surgical treatment. Two patients (4.2%) had long-term recurrence of GERD with necessity of a fundoplication re-do. We followed the clinic evolution of 39 patients (mean time of follow-up 2.9 years) and the weight percentile improved significantly during follow-up. Twenty-nine (79.5%) had no more symptoms of gastroesophageal reflux. Gastrostomy was removed in 7 patients. NF in infants under 12 months of age can be considered a safe, effective and feasible treatment of GERD with good results and low rate of recurrence needing surgical re-do. This surgical procedure can solve GERD and avoid its life-threatening complications in a vulnerable population with complex comorbidities.