Italian multicenter survey on laparoscopic treatment of gastro-esophageal reflux disease in children.
BACKGROUND
Skepticism is still present today about the laparoscopic treatment of gastro-esophageal reflux (GER) in children. We present the prospective experience and short-term results of eight Italian pediatric surgical units.


METHODS
We included all the children with complicated GER, operated after January 1998 by single surgeons from eight different centers. Diagnostic aspects, type of fundoplication, and complications were considered. All the patients were followed for a minimum period of 6 months in order to detect complications or recurrences.


RESULTS
288 children were prospectively included. Mean age was 4.8 years (3 m-14 y). Nissen fundoplication was done in 25%, floppy Nissen in 63%, Toupet in 1.7%, and anterior procedures (Lortat Jacob, Thal) in 10%. Gastrostomy was associated, if neurological impairment or feeding disorders were present. Mean follow-up was 15 months and reoperation was necessary in 3.8% of cases.


CONCLUSIONS
This experience underlines that minimal invasive access surgery in children is safe and that the laparoscopic approach is considered in eight centers the golden standard for surgical repair of gastro-esophageal reflux disease maintaining the same indications and techniques of the open approach.
Mattioli
G
G
Gaslini Research Institute, University of Genova, Italy. girolamomattioli@ospedale-gaslini.ge.it
Esposito
C
C
Lima
M
M
Garzi
A
A
Montinaro
L
L
Cobellis
G
G
Mastoianni
L
L
Aceti
M G R
MG
Falchetti
D
D
Repetto
P
P
Pini Prato
A
A
Leggio
S
S
Torri
F
F
Ruggeri
G
G
Settimi
A
A
Messina
M
M
Martino
A
A
Amici
G
G
Riccipetitoni
G
G
Jasonni
V
V
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods / Q000706:statistics & numerical data; D019538:Health Care Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology / Q000601:surgery; D007558:Italy; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data