title: Laparoscopic fundoplication in children with previous abdominal surgery.
abstract: OBJECTIVE
  In our institution, many children requiring antireflux surgery for gastroesophageal reflux have had previous abdominal surgery, usually gastrostomy tube or ventriculoperitoneal (VP) shunt placement. The authors review their laparoscopic Nissen fundoplication (LNF) experience in children with previous abdominal surgery assessing surgical outcome.
  
  
  METHODS
  A total of 82 consecutive LNFs performed at our institution between January 1996 and September 1998 were reviewed. Follow-up ranged from 1 month to 32 months (average, 8.9 months). LNF was performed without dividing short gastric vessels (Rosetti modification) through a standard 5-port technique.
  
  
  RESULTS
  A total of 26 of 82 patients (31.7%) had previous abdominal surgery and were divided into 2 groups: gastrostomy (n = 17) and VP shunt (n = 11) with 2 crossovers. A total of 14 of 17 (82.3%) in the gastrostomy group had percutaneous endoscopic gastrostomy (PEG) placement versus 3 of 17 (17.6%) by open technique (open). Four patients in the VP group had multiple surgeries (range, 1 to 10, average, 2.3). LNF was completed in 25 of 26 (96.2%). One operation was converted to an open procedure because of severe adhesions. In 13 of 17 (76.5%) the previous gastrostomy was not taken down. In 4 of 17 (23.5%), the gastrostomy was taken down to complete the procedure: 2 of 3 (66.7%) of the open group versus 2 of 14 (14.3%) of the PEG group. All 11 (100%) of the VP group had successful LNF. Two of 11 (18.2%) had shunt dysfunction at 2 months (shunt infection) and 4 months (clogged distal shunt), respectively. There have been no cases of recurrent reflux, and all gastrostomies and VP shunts were functional at the time of this report.
  
  
  CONCLUSIONS
  Previous abdominal surgery is common in children with gastroesophageal reflux disease requiring an antireflux procedure. The authors conclude from these preliminary results that laparoscopic Nissen fundoplication can be performed safely with minimal morbidity and excellent functional results in children with gastrostomies or ventriculoperitoneal shunts.
authors.affiliation: Children's Hospital of New Orleans, LA 70118, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Liu
authors.forename: G J
authors.initials: GJ
authors.lastname: Flattmann
authors.forename: M T
authors.initials: MT
authors.lastname: Karam
authors.forename: B I
authors.initials: BI
authors.lastname: Siegrist
authors.forename: W A
authors.initials: WA
authors.lastname: Loe
authors.forename: C B
authors.initials: CB
authors.lastname: Hill
mesh_terms: D000005:Abdomen / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011677:Punctures