title: Fundoplication in paediatric surgery: a survey in 40 German institutions.
abstract: BACKGROUND
  There is no generally accepted standard surgical approach to gastrooesophageal reflux disease (GERD) at present. However, laparoscopic fundoplication has been advocated to be the procedure of choice for gastrooesophageal reflux disease in children. We aimed to assess the standards of the diagnostic workup and operative techniques in paediatric surgical institutions in Germany.
  
  
  METHODS
  A questionnaire including 14 items was sent to all 71 departments of paediatric surgery in Germany. Forty (56 %) took part in the survey. Concepts of routine diagnostic workup, operative techniques, number of procedures, and conversions were assessed.
  
  
  RESULTS
  The average annual frequency of fundoplications was less than 20 in 36 units (90 %). Experience with laparoscopic fundoplication was present in 24 institutions (60 %). In 19 out of these (79 %) fewer than 50 laparoscopic fundoplications had been performed altogether up to the time of the survey. Out of 584 fundoplications performed in the year 2002, 184 (32 %) had been done laparoscopically. The ratio of conventional versus laparoscopic fundoplication was 170/130 (57/43 %) in academic, and 226/54 (81/19 %) in non-academic departments. The preferred technique of fundoplication, irrespective of the approach, was the Nissen wrap in 28 (70 %) of the departments. The number of paediatric surgeons performing laparoscopic fundoplication was 1 - 2 in 16 institutions (67 %), 3 or 4 in 6 (25 %), and 5 in 2 (8 %) departments. The conversion rate was reported to be less than 5 % in 15 departments (63 %), and 5 - 10 % in 3 (13 %).
  
  
  CONCLUSIONS
  The laparoscopic approach for surgical repair of GERD in children is not yet generally accepted in Germany. In most departments, training remains problematic due to low numbers of procedures. However, the feasibility of laparoscopic fundoplication in Germany is excellent, with a low rate of conversions.
authors.affiliation: Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany. Schmidt.Annika@MH-Hannover.de
authors.forename: A I
authors.initials: AI
authors.lastname: Schmidt
authors.forename: S
authors.initials: S
authors.lastname: Glüer
authors.forename: B M
authors.initials: BM
authors.lastname: Ure
mesh_terms: D002648:Child; D002983:Clinical Competence; D018662:Fundoplication / Q000379:methods / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D010535:Laparoscopy