Abstract
Background
The laparoscopic Nissen fundoplication has become a frequently performed procedure in infants and children who suffer from gastroesophageal reflux disease (GERD). In this study we describe our 8-year experience with 106 consecutive laparoscopic Nissen fundoplications.
Methods
From January 1994 to May 2002, we included 106 consecutive patients (57 neurologically normal (NN) and 49 neurologically impaired (NI)). The indications were symptomatic GERD, pulmonary symptoms or a combination of both. Patient’s outcome was assessed by symptom evaluation, technical examinations and a questionnaire.
Results
Mortality was 0% and conversion rate was 2.8%. Major postoperative complications occurred in 12 patients, mostly neurologically impairment. Dysphagia occurred in 23 patients of which 4 required dilatations and 2 a redo Nissen. Gas bloating occurred in 15 children, with spontaneous regression in all. Recurrent pneumopathies were seen in four children. Documented recurrence of reflux occurred in three symptomatic patients. Redo laparoscopic surgery was performed in six patients.
A questionnaire was sent to each patient’s parents. This showed that most patients had a normal or clearly improved quality of life (93.1% NN, 90.5% NI). Most patients were satisfied with the result and up to 39.5% gave a maximum satisfaction score.
Conclusion
The laparoscopic Nissen fundoplication can safely be performed with a low conversion rate and no surgical mortality in neurologically normal and neurologically impaired children. Neurologically impaired children are more susceptible to per- and postoperative complications. A good quality of life and a high index of satisfaction could be achieved in most patients.
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References
Carré IJ (1985) The natural history of the partial thoracic stomach in children. Arch Dis Child 34:344–353
Hassall E (2005) Decisions in diagnosing and managing chronic gastroesophageal reflux disease in chidren. J Pediatr 146:S3–S12
Gibbons TE, Stockwell J, Kreh RP (2001) Population-based epidemiology of gastroesophageal reflux disease in hospitalized U.S. children. Gastroenterology 20:419
Nelson SP, Chen EH, Syniar GM, Christoffel KK (1997) Prevalence of symptoms of gastroesophageal reflux during infancy. A paediatric practice-based survey. Paediatric Practice Research Group. Arch Pediatr Adolesc Med 151:569–572
Nelson SP, Chen EH, Syniar GM, Christoffel KK (2000) Prevalence of symptoms of gastroesophageal reflux during childhood. A pediatric practice based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 154:150–154
Esposito C, Montupet P, Amici G, Desruelle P (2000) Complications of laparoscopic antireflux surgery in childhood. Surg Endosc 14:622–624
Esposito C, Van Der Zee DC, Settimi A, Doldo P, Staiano A, Bax NM (2003) Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired children. Surg Endosc 17:708–710
Hossein A, Captier G, Lopez M, Forgues D, Galifer RB (2001) Evaluation of 142 consecutive laparoscopic fundoplications in children: Effects of the learning curve and technical choice. J Pediatr Surg 36:921–926
Mattioli G, Esposito C, Lima M, Garzi A, Montinaro L, Cobellis G, Mastoianni L, Aceti MG, Falchetti D, Repetto P, Pini Prato A, Leggio S, Torri F, Ruggeri G, Settimi A, Messina M, Martino A, Amici G, Riccipetitoni G, Jasonni V (2002) Italian multicenter survey on laparoscopic treatment of gastroesophageal reflux disease in children. Surg Endosc 16:1666–1668
Rothenberg S (1998) Experience with 220 consecutive laparoscopic Nissen fundoplications in infants and children. J Pediatr Surg 33:274–278
Pearl RH, Robi DK, Ein SH, Shandling B, Wesson DE, Superina R, Mctaggart K, Garcia VF, O’Connor JA, Filler RM (1990) Complications of gastroesophagal antireflux surgery in neurologically impaired versus neurologically normal children. J Pediatr Surg 11:1169–1173
Graziano K, Teitelbaum DH, McLean K, Hirschl RB, Coran AG, Geiger JD (2003) Recurrence after laparoscopic and open Nissen fundoplication. Surg Endosc 17:704–707
Kawahara H, Nakajima K, Yagi M, Okuyama H, Kubota A, Okada A (2002) Mechanisms responsible for recurrent gastroesophagal reflux in neurologically impaired children who underwent laparoscopic Nissen fundoplication. Surg Endosc 16:767–771
Kawahara H, Imura K, Nakajima K, Yagi M, Kamata S, Okada A (2000) Motor function of the oesophagus and the lower oesophageal sphincter in children who undergo laparoscopic Nissen fundoplication. J Pediatr Surg 35:1666–1671
Pimpalwar A, Najmaldin A (2002) Results of laparoscopic antireflux procedures in neurological impaired children. Semin Laparosc Surg 9:190–196
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Mathei, J., Coosemans, W., Nafteux, P. et al. Laparoscopic Nissen fundoplication in infants and children: analysis of 106 consecutive patients with special emphasis in neurologically impaired vs. neurologically normal patients. Surg Endosc 22, 1054–1059 (2008). https://doi.org/10.1007/s00464-007-9578-0
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DOI: https://doi.org/10.1007/s00464-007-9578-0