Laparoscopic refundoplication in children.
BACKGROUND
Gastroesophageal fundoplication currently is one of the three most common major operations performed on infants and children by pediatric surgeons in the United States. With the advent of laparoscopic surgery, the number of gastroesophageal fundoplications has virtually exploded. Morbidity always was substantial with this operation, and laparoscopy has not changed this. We describe our results with laparoscopic refundoplication in infants and children.


METHODS
From December 1993 to December 1998 100 children underwent a laparoscopic 180 degrees anterior wrap using the Thal procedure. Four children had to undergo a laparoscopic refundoplication. Two of these children were mentally handicapped. All of the children had recurrent symptoms, but only two of the four had an abnormal pH study. In three of the children, the Thal procedure was changed to a Nissen (n = 2) and Toupet (n = 1) fundoplication. One child with an intrathoracic wrap and a giant hiatal hernia underwent hernia repair with a Goretex patch and a redo-Thal.


RESULTS
In two of the children, the operation was relatively simple. For one child, the procedure had to be converted for anesthesiologic reasons. The procedure in the fourth child was more difficult because of a large hiatal hernia. Within a follow-up time of 2 to 4 years, all the children were free of pathologic gastroesophageal reflux symptoms and afterward displayed no recurrence.


CONCLUSIONS
In children, laparoscopic refundoplication after a previous laparoscopic antireflux Thal procedure is feasible and does not increase morbidity.
van der Zee
D C
DC
Department of Pediatric Surgery, KE 04.140.5 Wilhelmina Children's Hospital, University Medical Centre Utrecht, Post Office Box 85090, 3508 AB, Utrecht, The Netherlands.
Bax
N M
NM
Ure
B M
BM
D000293:Adolescent; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012008:Recurrence; D012086:Reoperation / Q000379:methods