Abstract
Purpose
: When gastroesophageal reflux (GER) is unresponsive to medical management, life-threatening complications may mandate surgical intervention in the very young. The aim of this study was to determine whether laparoscopic Nissen fundoplication in babies less than 3 months of age or 3.5 kg is safe and effective.
Methods
: The medical records from three institutions of all patients younger than 3 months of age or <3.5 kg undergoing fundoplication were reviewed. The short gastric vessels were routinely divided, and the crura were reapproximated. Short floppy 360° wraps were fashioned over a bougie (22F-30F) with two to four sutures incorporating the anterior esophagus. Laparoscopic Nissen fundoplication was performed in 104 infants fulfilling the size or weight criteria. Eighty two patient had concurrent gastrostomies. The mean age and weight were 68 days and 3.1 kg, respectively.
Results
: The mean operative time was 60 minutes, and the patients were at full feedings by a mean of 3 days. The mean patient follow-up is more than 150 days. One patient was converted to the open technique. There were 12 major complications (10.7%), which were related to laparoscopy (4), gastrostomy (4), patient selection (1), fundoplication (2), and pulmonary (1). One infant with a malpositioned gastrostomy tube still has occasional emesis; all others have no clinical evidence of GER. There was one death in an infant with trisomy 18 and a gastrostomy tube leak.
Conclusions
: Small infants requiring fundoplication may be safely managed with this minimally invasive technique. Most complications are attributable to technical errors and can be avoided; pulmonary complications and bowel obstruction are minimized.
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