Laparoscopic antireflux surgery in children An analysis of 20 patients

Abstract

Aim To study the efficacy and feasibility
of laparoscopic antireflux surgery in children.
Settings and design Descriptive
study Materials and methods Twenty one
patients between 3 months and 12 years
(mean 4.3years), weighing 2.8 Kg to 40
Kg (average 13 Kg) underwent laparoscopic
Nissen fundoplication with or without
laparoscopy assisted feeding gastrostomy
between 2009 and 2011. The
indications for surgery were persistent
symptoms despite adequate medical
treatment or complicated reflux disease.
Eight children were neurologically impaired.
The other symptoms from the reflux
included recurrent respiratory infection
(n17), failure to thrive (n12) and
vomiting (n4). Five children were being
treated for respiratory illness when GER
was diagnosed. All patients were diagnosed
by a barium swallow preoperatively.
All but one patient were given a
three month trial of medical therapy.
Fifteen patients had Nissen fundoplication
alone and six had additional
laparoscopically assisted feeding
gastrostomy. Conversion to open surgery
was necessary in one patient due to dilated
bowel loops impairing vision. Fifteen patients
had good symptomatic relief. The
complications include transient dysphagia
(n1), transient vomiting (n1), persistent
vomiting (n1), persistent dysphagia (n1),
duodenal blow out during gastrostomy
change (n1). Two patients died one from a
missed ileal perforation and the other three
weeks after surgery due to an unrelated
cause. Conclusions Laparoscopic Nissen
fundoplication in children shows a good
overall success rate (80) in terms of complete
relief of symptoms. It confers a definite
pulmonary advantage over open surgery
in neurologically impaired children and
in children with respiratory involvement.