Prior Gastrostomy Does Not Preclude Successful Laparoscopic Fundoplication

Abstract

Background

: The presence of a gastrostomy may be considered a relative contraindication to the increasingly popular laparoscopic fundoplication.

Patients and Methods

: Between September 1998 and September 1992, 22 patients underwent attempted laparoscopic fundoplication. Ten patients had undergone a previous gastrostomy, nine by percutaneous endoscopic methods and one by open surgery. In one case, the gastrostomy tube had been removed long before the current procedure. A standard minimally invasive approach utilizing five 5-mm ports was used. When a gastrostomy was present, the left upper-quadrant port site was placed to allow equal access to both sides of the stomach.

Results

: Laparoscopic fundoplication was successful in 21 of the 22 patients, including all patients with a previous gastrostomy. One patient required takedown and replacement of the gastrostomy, which was performed laparoscopically. Operative times have decreased steadily during the series and average approximately 117 minutes when no gastrostomy is present (N = 4) and 137 minutes when a gastrostomy is present (N = 4).

Conclusion

: Prior gastrostomy is not a contraindication to successful laparoscopic fundoplication and appears to add little to the total duration of the operative procedure.