Abstract
ABSTRACT
Forty consecutive pediatric patients (31 normal and 9 neurologically impaired children) were operated on for the symptoms and complications of gastroesophageal reflux (GER). The authors performed 18 Nissen and 22 Toupet procedures. Clinical data about the learning curve of this series consisted of operative time, perioperative and postoperative morbidity, and postoperative hospital stay. There were three conversions: first, to control sutures; second, after a gastric perforation; and the last, for the technical impossibility of continuing because of gaseous intestinal distention. The mean operative time was 1 hour and 45 minutes. Early postoperative complications consisted of pneumothorax (1) and bleeding (1), which required an early second look. The mean hospital stay was 3 days. There was 1 death. Recurrence occurred in 1 patient at a mean follow-up of 12 months, requiring repeat fundoplication. It is concluded that after a short learning curve of ~20 patients, the early results of minimally invasive fundoplication in children tend to be better than those obtained by the open procedure. This technique requires a surgeon experienced in basic laparoscopic procedures because of the small operative space.
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