Laparoscopic gastric antroplasty in children with delayed gastric emptying and gastroesophageal reflux
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Updated: Oct 30, 2026
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Published on: August 11, 2023
L K Sampson1, K E Georgeson, S A Royal
1The University of Alabama at Birmingham, Department of Surgery, The Children's Hospital of Alabama, 35233, USA.
Insights
Laparoscopic gastric antroplasty effectively treats delayed gastric emptying (DGE) in children undergoing fundoplication for gastroesophageal reflux (GER). This minimally invasive procedure improves gastric emptying and resolves GER symptoms.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Delayed gastric emptying (DGE) affects 50% of children with gastroesophageal reflux (GER).
- Surgical intervention for GER in DGE patients, including gastric outlet procedures, remains controversial.
Purpose of the Study:
- To describe the technique and clinical outcomes of laparoscopic gastric antroplasty.
- To evaluate the efficacy of laparoscopic antroplasty combined with fundoplication for GER and DGE in pediatric patients.
Main Methods:
- Retrospective review of 61 pediatric patients undergoing laparoscopic gastric antroplasty and fundoplication.
- Documented DGE confirmed by isotope meal retention.
- Laparoscopic antroplasty involved a linear pyloric and antral incision, with transverse closure.
Main Results:
- 57 of 61 patients had successful laparoscopic antroplasty with resolution of GER and DGE.
- Two patients experienced transient dumping syndrome, managed with smaller feedings.
- One patient had an omental evisceration; four required conversion to open antroplasty.
Conclusions:
- Laparoscopic gastric antroplasty is a clinically effective adjunct to fundoplication for pediatric GER patients with DGE.
- The procedure demonstrates efficacy in improving delayed gastric emptying.
Background/Purpose:
A significant number of children (50%) with gastroesophageal reflux (GER) have delayed gastric emptying (DGE). Although controversial, many pediatric surgeons use a gastric outlet procedure in conjunction with fundoplication for gastroesophageal reflux in these patients. This paper describes the technique and clinical outcome of 61 patients undergoing a laparoscopic gastric antroplasty at the time of the laparoscopic fundoplication.
Methods:
The charts of 61 patients who underwent laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication between May 26, 1992 and October 17, 1996 were reviewed retrospectively. All patients had a documented DGE confirmed by a liquid isotope meal being retained in the stomach. After completion of the fundoplication, a laparoscopic antroplasty was performed by incising a 2 to 3.5-cm linear incision in the pylorus and distal gastric antrum. The seromuscular wall was divided to the level of the mucosa allowing the mucosa to bulge through the defect. The wound was closed transversely using interrupted 2-0 silk sutures.
Results:
Four of the 61 patients underwent conversion to open antroplasty for technical reasons. The remaining 57 patients recovered uneventfully from the laparoscopic antroplasty with clinical resolution of both GER and DGE. Two of 57 patients had intermittent episodes of retching and were unable to tolerate large bolus feedings because of dumping. They were treated by dividing the feedings into two smaller portions. These symptoms cleared within 6 months. The remaining 55 patients have tolerated feedings well. Evaluation of the gastric emptying was performed randomly in selected patients with documented improvement of the emptying after antroplasty. An evisceration of omentum through the umbilical incision developed in one patient on the third postoperative day.
Conclusions:
Patients with delayed gastric emptying who need fundoplication can be treated with laparoscopic gastric antroplasty in conjunction with laparoscopic fundoplication. Laparoscopic antroplasty appears to be clinically efficacious in improving delayed gastric emptying.
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