Evolution of the modified Rossetti fundoplication in children: surgical technique and results.
OBJECTIVE
To compare the modified Rossetti fundoplication with the classic Nissen.


BACKGROUND
The traditional surgical treatment of gastroesophageal reflux in children has been the classic Nissen fundoplication, defined by liver mobilization, crural repair, takedown of short gastric vessels, and floppy wrap. The authors have progressed in our technique of fundoplication and now perform a modified Rossetti fundoplication, defined by liver retraction without mobilization, no crural repair, short gastric vessels left intact, and 2-cm floppy wrap.


METHODS
A retrospective chart review was performed on 407 pediatric patients who had open fundoplications (Jan. 13, 1993, to Feb. 25, 1998). Two groups were analyzed: the Nissen group (171 patients) and the Rossetti group (236 patients). Groups were compared for incidence of recurrent reflux, dysphagia, hiatal hernia, need for esophageal dilation, revision of fundoplication, time to discharge, and operative time.


RESULTS
Incidence of dysphagia (3.7% vs. 3.3%), postoperative hiatal hernia (1.9% vs. 1.4%), need for esophageal dilation (1.2% vs. 0.5%), and need for fundoplication revision (2.5% vs. 2.3%) were similar between the groups. The mean operative time was significantly decreased in the Rossetti group (65 +/- 25 minutes) versus the Nissen group (73 +/- 33 minutes). Recurrent reflux occurred significantly more often in the Nissen group (11.2%) than in the Rossetti group (5.1 %).


CONCLUSIONS
The modified Rossetti fundoplication has a low complication rate and is the authors' preferred method for the surgical treatment of gastroesophageal reflux in children.
Levy
M S
MS
Division of Pediatric Surgery, Arkansas Children's Hospital, Little Rock 72202-3591, USA.
Sorrels
C W
CW
Wagner
C W
CW
Jackson
R J
RJ
Barnes
R W
RW
Smith
S D
SD
D002675:Child, Preschool; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome