title: Does laparoscopy lower the threshold for the surgical treatment of gastroesophageal reflux disease in children?
abstract: OBJECTIVE
  To assess whether laparoscopic surgery lowers the threshold for surgical intervention, we examined whether the introduction of the laparoscopic technique at our institution in 1997 has resulted in an increase in antireflux surgery in children at our clinic.
  
  
  METHODS
  The number of annual fundoplications between 1997 and 2008 at a single institution was assessed in children younger than 18 years. The number of fundoplications was compared with the number of pyloromyotomies and appendicectomies per year in the same period of time to prove or exclude a general increase in the referral of children.
  
  
  RESULTS
  Since 1997, the proportion of laparoscopic fundoplications increased from 60% in 1997 to 100% in 2008. During this period, 109 laparoscopic fundoplications were performed: 31 in the period from 1997 to 2002 and 78 from 2003 to 2008. Regression analysis shows a significant increase in the number of performed fundoplications (slope: 1.03 ± 0.28, P = 0.0043), whereas both the number of pyloromyotomies and appendicectomies remained stable (slopes: -0.14 ± 0.40, P = 0.73, and -0.75 ± 0.47, P = 0.14, respectively).
  
  
  CONCLUSIONS
  Since the introduction of minimally invasive surgery at our tertiary referral center in 1997, the number of patients referred for an antireflux operation has increased. This cannot be explained by an increase of referrals from outside the region or a change in the indication for surgery. We conclude that laparoscopy lowers the threshold for the surgical treatment of gastroesophageal reflux disease in children.
authors: Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. cdriessen@gmail.com
authors: Caroline
authors: C
authors: Driessen
authors: B H
authors: BH
authors: Verhoeven
authors: W E Tjon A
authors: WE
authors: Ten
authors: L W E
authors: LW
authors: Van Heurn
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000379:methods / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis