Laparoscopic Fundoplication Yields Low Postoperative Pulmonary Complications in Neurologically Impaired Children

Abstract

ABSTRACT

Neurologically impaired (NI) children with gastroesophageal reflux (GER) are a subset of patients with a high incidence of early postoperative pneumonia and recurrence of reflux after open fundoplication. Patients undergoing laparoscopic fundoplication have less postoperative pain and postoperative splinting allowing them to have effective deep coughing and return to normal activity levels sooner. Additionally, there is less exposure to nosocomial infections since patients undergoing laparoscopy have shorter hospital stays. In a retrospective review of 113 consecutive laparoscopic fundoplications in NI children, 2 cases of early postoperative pneumonia occurred (1.8%). This compares to the reported pneumonia incidence of 14 to 40% after open fundoplication in the literature.^1–5 We had 2 cases of recurrence of reflux disease, which yields a recurrence rate of 1.8% with an average follow– up of 17 months. Due to the low recurrence rate and low incidence of postoperative pneumonia, laparoscopic fundoplication is our preferred method for surgical treatment of GER in high-risk NI children.