title: Laparoscopic versus open Nissen fundoplication in infants after neonatal laparotomy.
abstract: BACKGROUND
  Nissen fundoplication is an effective treatment of gastroesophageal reflux in infants. Laparoscopic procedures after previous laparotomy are technically more challenging. The role of laparoscopic Nissen fundoplication after neonatal laparotomy for diseases unrelated to reflux is poorly described.
  
  
  METHODS
  This was a retrospective review of open vs laparoscopic Nissen fundoplication in infants after neonatal laparotomy. Of 32 infants who underwent neonatal laparotomy, 26 required a surgical antireflux operation within the first year of life. Twelve infants underwent laparoscopic Nissen fundoplication versus 14 infants who underwent open Nissen fundoplication. Parameters like age, weight, operative time, number of previous operations, length of stay following fundoplication, time to feedings, and complications were compared between the 2 groups.
  
  
  RESULTS
  No statistically significant differences existed between most of the parameters compared following laparoscopic vs open Nissen fundoplication. No conversions to open procedures were necessary in infants undergoing laparoscopic fundoplication, and these infants resumed enteral feeds earlier than those who underwent the open procedure.
  
  
  CONCLUSIONS
  Laparoscopic compared with open Nissen fundoplication performed in infants after a neonatal laparotomy were comparable procedures across most data points studied. However, a laparoscopic fundoplication did allow for earlier return to enteral feeds compared with the open approach. Laparoscopic Nissen fundoplication is technically feasible, safe, and effective in the treatment of gastroesophageal reflux in infants with a previous neonatal laparotomy.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Pittsburgh Medical Center, The Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Barsness
authors.forename: Alexander
authors.initials: A
authors.lastname: Feliz
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Potoka
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gaines
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Upperman
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Kane
mesh_terms: D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007813:Laparotomy; D007902:Length of Stay; D012086:Reoperation; D012189:Retrospective Studies