title: Functional results of laparoscopic fundoplication in children.
abstract: BACKGROUND
  There is no evidence that the results of laparoscopic fundoplication in children match those of the open procedure. In the current report, pre- and postoperative function of the antireflux barrier is examined in children having laparoscopic fundoplication for gastroesophageal reflux.
  
  
  METHODS
  Twenty-seven patients with gastroesophageal reflux, aged 7.2+/-4.5 years, were operated on for unremitting gastrointestinal symptoms (n = 24), with respiratory tract disease (n = 11), cystic fibrosis (n = 2), or brain damage (n = 11). Gastrostomy was added in 5 cases. Barium contrast study, pH-metering, endoscopic examination, and biopsy were performed before and after a median of 19 months (range, 8 to 46) after operation.
  
  
  RESULTS
  At diagnosis, 15 of 21 patients had esophagitis that was moderate or severe in 11 (1 with Barrett's esophagus). Symptoms disappeared after fundoplication in all but 2 patients, in whom they became milder. The reflux index decreased from 20.2+/-20% to 4.9+/-9% and became normal in all except 4 children (2 with brain damage and 1 with cystic fibrosis). Open repair of the failed wrap was considered necessary in only 1 of them.
  
  
  CONCLUSIONS
  Laparoscopic fundoplication is as effective as the open procedure (14% overall failure rate). However, the failure rate in neurologic patients (18%) suggests that before reaching conclusions on the benefits of this approach, careful long-term assessment of the functional results is necessary.
authors.affiliation: Department of Pediatric Surgery, Hospital Infantil Universitario La Paz, Madrid, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar
authors.forename: P
authors.initials: P
authors.lastname: Olivares
authors.forename: M
authors.initials: M
authors.lastname: Diaz
authors.forename: R A
authors.initials: RA
authors.lastname: Pace
authors.forename: G
authors.initials: G
authors.lastname: Prieto
authors.forename: M
authors.initials: M
authors.lastname: Molina
mesh_terms: D001706:Biopsy; D001930:Brain Injuries / Q000150:complications; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D012140:Respiratory Tract Diseases / Q000150:complications; D016896:Treatment Outcome