title: Comparison of long-term outcomes between open and laparoscopic Thal fundoplication in children.
abstract: OBJECTIVE
  In recent years laparoscopic fundoplication is increasingly performed in pediatric surgery. The aim of this study was to compare the long-term outcomes between open and laparoscopic Thal fundoplication in children.
  
  
  METHODS
  This retrospective study includes children who underwent a Thal fundoplication between 3/1997 and 7/2009. The minimum follow-up time to enter the study was 2 years; the overall median follow-up was 77 months (range, 29-176 months).
  
  
  RESULTS
  A total of 101 patients were included, of which 47 underwent an open and 54 a laparoscopic Thal. Intraoperative problems, early postoperative complications, time to establish enteral feeds and length of stay did not differ among both groups. The mean duration of surgery was significantly less in the open group (OPG) (108.0 (± 7.72) versus 144.1 (± 6.36) minutes; p=0.001) and this was mainly attributed to patients with neurological problems. Severe dysphagia requiring endoscopy was observed in 10 patients, but this did not differ significantly between groups (n=2 in the OPG vs. n=8 in the laparoscopic group (LAPG); p=0.10). Overall 12 patients (11.9%) (6 in each group) required a redo-fundoplication after a median of 18.7 months (range, 6-36 months). In the whole study group, 80 patients (79.2%) were classified as having surgical results being excellent, good or satisfactory and this did not differ significantly between groups.
  
  
  CONCLUSIONS
  In the long-term open and laparoscopic Thal fundoplication have similarly good outcomes. The laparoscopic approach can be considered as an alternative, however there is not a clear superiority compared with the open counterpart.
authors: Department of Pediatric Surgery, Mannheim Medical School (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany. Electronic address: rainerkubiak@hotmail.com.
authors: Rainer
authors: R
authors: Kubiak
authors: Department of Pediatric Surgery, Mannheim Medical School (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
authors: Elena
authors: E
authors: Böhm-Sturm
authors: Department of Pediatric Surgery, Mannheim Medical School (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
authors: Daniel
authors: D
authors: Svoboda
authors: Department of Pediatric Surgery, Mannheim Medical School (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
authors: Lucas M
authors: LM
authors: Wessel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Children; Fundoplication; Gastroesophageal reflux; Laparoscopy; Thal