Laparoscopic fundoplication in children: our first 30 cases

We report our experience performing 30 laparoscopic fundoplications in children (24 using the Nissen Rossetti technique and 6 using the Toupet fundoplication). Special instruments adapted to the young children are used: first, a miniature parietal suspender to decrease the intra-abdominal pressure and to provide more space; second, a retractable losenge-shaped liver retractor; and third, a Babcock forceps articulated at 60 degrees. In the Nissen Rossetti procedure, the wrap is fixed to the anterior face of the esophagus, the anterior wall of the fundus, and the upper right crus. In the Toupet procedure, the wrap is a retroesophageal partial fundoplication: the first suture attaches the wrap to the right crus, the second attaches the wrap to the esophagus, and the third recreates the oesogastric angle. We do not use gastrostomy. Patients have no gastric tube after the intervention. Thirty children from 2 to 15 years have undergone laparoscopic fundoplications. One conversion to open procedure was necessary. An average follow-up of 12 months was observed for 18 children with 3 complications: dysphagia for a psychotic girl, intrathoracic valve without any trouble, and recurrent episodes of digestive bleedings during 6 months. Laparoscopic fundoplication is a feasible extension of minimally invasive surgery in the hands of experienced surgeons; however limitations must be recognized to do a safe operation.