title: Laparoscopic Nissen fundoplication in infants and children: analysis of 106 consecutive patients with special emphasis in neurologically impaired vs. neurologically normal patients.
abstract: BACKGROUND
  The laparoscopic Nissen fundoplication has become a frequently performed procedure in infants and children who suffer from gastroesophageal reflux disease (GERD). In this study we describe our 8-year experience with 106 consecutive laparoscopic Nissen fundoplications.
  
  
  METHODS
  From January 1994 to May 2002, we included 106 consecutive patients (57 neurologically normal (NN) and 49 neurologically impaired (NI)). The indications were symptomatic GERD, pulmonary symptoms or a combination of both. Patient's outcome was assessed by symptom evaluation, technical examinations and a questionnaire.
  
  
  RESULTS
  Mortality was 0% and conversion rate was 2.8%. Major postoperative complications occurred in 12 patients, mostly neurologically impairment. Dysphagia occurred in 23 patients of which 4 required dilatations and 2 a redo Nissen. Gas bloating occurred in 15 children, with spontaneous regression in all. Recurrent pneumopathies were seen in four children. Documented recurrence of reflux occurred in three symptomatic patients. Redo laparoscopic surgery was performed in six patients. A questionnaire was sent to each patient's parents. This showed that most patients had a normal or clearly improved quality of life (93.1% NN, 90.5% NI). Most patients were satisfied with the result and up to 39.5% gave a maximum satisfaction score.
  
  
  CONCLUSIONS
  The laparoscopic Nissen fundoplication can safely be performed with a low conversion rate and no surgical mortality in neurologically normal and neurologically impaired children. Neurologically impaired children are more susceptible to per- and postoperative complications. A good quality of life and a high index of satisfaction could be achieved in most patients.
authors.affiliation: Thoracic Surgery, University Hospitals Gasthuisberg, 3000, Leuven, Belgium. jan_mathei@hotmail.com
authors.forename: Jan
authors.initials: J
authors.lastname: Mathei
authors.forename: Willy
authors.initials: W
authors.lastname: Coosemans
authors.forename: Philippe
authors.initials: P
authors.lastname: Nafteux
authors.forename: George
authors.initials: G
authors.lastname: Decker
authors.forename: Paul
authors.initials: P
authors.lastname: De Leyn
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
authors.forename: Ilse
authors.initials: I
authors.lastname: Hoffman
authors.forename: Christiane
authors.initials: C
authors.lastname: Deboeck
authors.forename: Marijke
authors.initials: M
authors.lastname: Proesmans
authors.forename: Toni
authors.initials: T
authors.lastname: Lerut
mesh_terms: D000293:Adolescent; D018893:Bronchoalveolar Lavage; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D009422:Nervous System Diseases / Q000150:complications*; D011183:Postoperative Complications; D011788:Quality of Life; D012086:Reoperation; D016896:Treatment Outcome