Laparoscopic Nissen–Rossetti Fundoplication in Children

Abstract

Background and Purpose

: Children with severe gastroesophageal reflux (GER) often require antireflux surgery. Between January 1996 and December 1999, 117 children underwent laparoscopic Nissen-Rossetti fundoplication (LNRF) at the Children's Hospital of New Orleans. We reviewed their charts, assessing the surgical outcome.

Patients and Methods

: Barium swallow, pH probe, or both demonstrating GER was performed in all children prior to fundoplication. All children underwent LNRF via a five-port technique by three surgeons. The following surgical outcome measures were assessed: success of completion of procedure, operative time, intraoperative and postoperative morbidity, and recurrence of GER. The mean follow-up was 1.2 years (range 2 months-3.2 years).

Results

: The LNRF was completed in 114 patients (97.4%). The mean operative time was 2 hours 2 minutes (range 45 minutes-4 hours 7 minutes). There were no operative deaths. Five patients (4.3%) experienced intraoperative complications, with three suffering esophageal perforation. Eight patients (6.8%) required subsequent esophageal dilatation, with four receiving gastrostomy tube placement for persistently poor oral intake secondary to refractory dysphagia or gas bloat. Two patients (1.7%) developed recurrent GER at 6 months and 2.1 years, with the latter patient requiring a redo Nissen procedure.

Conclusions

: Laparoscopic Nissen-Rossetti fundoplication can be performed safely and successfully in children with severe GER. Longer follow-up is needed to compare the rate of recurrent GER with that obtained by the traditional open or laparoscopic Nissen technique.