Laparoscopic Thal fundoplication in severely scoliotic children
Related Experiment Video
Updated: Nov 6, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
1Department of Pediatric Surgery, University Children's Hospital Wilhelmina, Utrecht, The Netherlands.
Insights
Laparoscopic Thal fundoplication offers improved surgical access and visibility for treating gastroesophageal reflux in children with severe scoliosis. This minimally invasive approach resulted in good outcomes with short hospital stays and no symptomatic reflux post-surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Orthopedic Surgery
Background:
- Surgical treatment for gastroesophageal reflux in children with severe scoliosis presents challenges due to limited surgical workspace.
- The deep and often rotated hiatus in these patients complicates exposure during open procedures.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic Thal fundoplication in severely scoliotic children.
- To assess if the laparoscopic approach improves operative visibility and access compared to open surgery.
Main Methods:
- Laparoscopic Thal fundoplication was performed on five severely scoliotic children between February and December 1994.
- Four patients also underwent feeding gastrostomy.
- Postoperative assessment included pH studies at 3 months.
Main Results:
- No intraoperative complications were reported.
- The laparoscopic approach provided enhanced operative visibility and access to the hiatus.
- Mean hospital stay was 3 days.
- All patients showed no symptomatic postoperative gastroesophageal reflux, confirmed by pH studies.
Conclusions:
- Laparoscopic Thal fundoplication is a viable and effective surgical option for treating gastroesophageal reflux in severely scoliotic children.
- The technique offers advantages in visibility and access over traditional open surgery for this patient population.
Abstract:
Surgical treatment of gastroesophageal reflux in severely scoliotic children can be quite bothersome because sometimes the working space between the subcostal margins, iliac crest, and spinal column is very limited; the hiatus lies extremely deep away and is frequently rotated, making exposure more difficult. The laparoscopic approach could lend the necessary extension to the surgeons' hands to reach the deep hiatus. Moreover the entrance of the ports can be adjusted to the special requirements dictated by the scoliosis. Between February and December 1994 laparoscopic Thal fundoplication was performed in five severely scoliotic children; four also had a feeding gastrostomy. There were no intraoperative complications. The laparoscopic approach allowed improved operative visibility. Mean hospital stay was 3 days. The children displayed no symptomatic postoperative gastroesophageal reflux, which was confirmed by 3 months postoperative pH study. The laparoscopic approach of fundoplication allows improved visibility and easier access to the hiatus in severely scoliotic patients in comparison to the open approach. Results so far are good.
