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Laparoscopic fundoplication in infants and children
1Division of Pediatric Surgery, Department of Surgery, The Children's Hospital of Alabama, 300 ACC, 1600 7th Avenue South, Birmingham, AL 35233, USA.
Insights
Laparoscopic fundoplication offers a faster recovery and shorter hospital stay for pediatric gastroesophageal reflux disease. This minimally invasive approach shows comparable or improved complication rates versus open surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastroesophageal reflux disease (GERD) is a common condition in children.
- Laparoscopic fundoplication is an emerging surgical technique for managing pediatric GERD.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic fundoplication in a cohort of pediatric patients.
- To assess the safety and efficacy of laparoscopic Nissen and Toupet fundoplications.
Main Methods:
- Retrospective review of 160 children undergoing laparoscopic fundoplication.
- Procedures included Nissen or Toupet fundoplication, with concurrent gastrostomy and gastric outlet procedures as needed.
Main Results:
- Conversion to open surgery occurred in 7.5% of patients.
- Laparoscopic gastrostomies and gastric outlet procedures were performed in 75.7% and 41.9% of patients, respectively.
- Complication rates were low (7.4% for fundoplication, 8.0% for gastrostomy, 4.8% for gastric outlet procedures), with one surgical mortality (0.7%).
Conclusions:
- Laparoscopic fundoplication facilitates quicker patient recovery and reduced hospital stays.
- The complication rates are comparable or superior to traditional open fundoplication, supporting its use in pediatric GERD treatment.
Background:
Laparoscopic fundoplication is a new method for treating gastroesophageal reflux in children. We present 160 children with gastroesophageal reflux treated by laparoscopic fundoplication.
Methods:
Patients underwent either a laparoscopic Nissen or Toupet fundoplication. Many patients also required gastrostomies and gastric outlet procedures.
Results:
Twelve patients (7.5%) were converted to open fundoplication. Laparoscopic gastrostomies were placed in 112 patients (75.7%) and laparoscopic gastric outlet procedures in 62 patients (41.9%). Feedings were initiated by postoperative day 2 in 126 children (85.7%). Sixty-four percent were discharged by postoperative day 3. Complications occurred in 11 of 148 fundoplications (7.4%), in nine of 112 gastrostomies (8.0%), and in three of 62 gastric outlet procedures (4.8%). One patient died as a result of a surgical error in placing a gastrostomy (0.7%).
Conclusion:
Laparoscopic fundoplication appears to foster a more rapid recovery and decreased hospital stay while maintaining complication rates similar to or better than open fundoplication.
