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Functional results of laparoscopic fundoplication in children
J A Tovar1, P Olivares, M Diaz
1Department of Pediatric Surgery, Hospital Infantil Universitario La Paz, Madrid, Spain.
Insights
Laparoscopic fundoplication effectively treats gastroesophageal reflux in children, with symptoms resolving in most cases. Long-term assessment is needed, especially for neurologic patients, to fully evaluate functional results.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Laparoscopic fundoplication is increasingly used for pediatric gastroesophageal reflux.
- Comparative data on laparoscopic versus open fundoplication outcomes in children are limited.
Purpose of the Study:
- To evaluate the effectiveness of laparoscopic fundoplication in restoring the antireflux barrier in children.
- To compare functional outcomes of laparoscopic fundoplication with historical open repair data.
Main Methods:
- Study included 27 children (mean age 7.2 years) with gastroesophageal reflux.
- Pre- and postoperative assessments included barium studies, pH monitoring, endoscopy, and biopsy.
- Follow-up was a median of 19 months.
Main Results:
- Symptoms resolved or improved in all but 2 patients post-fundoplication.
- The reflux index significantly decreased, normalizing in most children.
- Esophagitis improved, with only one patient requiring open repair for wrap failure.
Conclusions:
- Laparoscopic fundoplication demonstrates comparable effectiveness to open procedures with a 14% failure rate.
- Neurologic impairment in pediatric patients may be associated with a higher failure rate (18%), necessitating careful long-term functional evaluation.
Background:
There is no evidence that the results of laparoscopic fundoplication in children match those of the open procedure. In the current report, pre- and postoperative function of the antireflux barrier is examined in children having laparoscopic fundoplication for gastroesophageal reflux.
Methods:
Twenty-seven patients with gastroesophageal reflux, aged 7.2+/-4.5 years, were operated on for unremitting gastrointestinal symptoms (n = 24), with respiratory tract disease (n = 11), cystic fibrosis (n = 2), or brain damage (n = 11). Gastrostomy was added in 5 cases. Barium contrast study, pH-metering, endoscopic examination, and biopsy were performed before and after a median of 19 months (range, 8 to 46) after operation.
Results:
At diagnosis, 15 of 21 patients had esophagitis that was moderate or severe in 11 (1 with Barrett's esophagus). Symptoms disappeared after fundoplication in all but 2 patients, in whom they became milder. The reflux index decreased from 20.2+/-20% to 4.9+/-9% and became normal in all except 4 children (2 with brain damage and 1 with cystic fibrosis). Open repair of the failed wrap was considered necessary in only 1 of them.
Conclusions:
Laparoscopic fundoplication is as effective as the open procedure (14% overall failure rate). However, the failure rate in neurologic patients (18%) suggests that before reaching conclusions on the benefits of this approach, careful long-term assessment of the functional results is necessary.