Functional results of laparoscopic fundoplication in children.
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.
Tovar
J A
JA
Department of Pediatric Surgery, Hospital Infantil Universitario La Paz, Madrid, Spain.
Olivares
P
P
Diaz
M
M
Pace
R A
RA
Prieto
G
G
Molina
M
M
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