title: [Management of gastroesophageal reflux in children. Single centre experience in conventional and laparoscopic Nissen fundoplication in the last 15 years].
abstract: BACKGROUND
  Nissen fundoplication (NF) is the most used and effective technique for the treatment of gastroesophageal reflux in children. The laparoscopic approach (LNF) is safe, with low morbidity and high success rate, although some cases require a conventional approach (CNF). The aim of the study is to compare the results between LNF and CNF in our centre.
  
  
  METHODS
  A retrospective review was performed on patients <14years after NF between 2000 and 2015. A comparison was made of the complications, hospital stay, and follow-up for both approaches.
  
  
  RESULTS
  Of the total 75 NF performed, 49 (65.3%) were LNF, 23 (30.7%) CNF, and 3 (4.0%) reconversions. Concomitant laparoscopic gastrostomy was performed in 10.7%, and open gastrostomy in 5.3% of cases. Prior to NF, 10.7% had a gastrostomy. The mean age was 4 years and 68.7% were male. Of the diagnoses, 36% had encephalopathy, 14.7% hiatal hernia, 5.4% oesophageal atresia, and 5.4% an acute life-threatening event. No differences were found in operation time. More than two-thirds (36%) had complications, which were more frequent in the CNF (OR=3.30, 95%CI: 1.1-9.6). The hospital-stay decreased by 9 days in the LNF (95%CI: 5.5-13.5). Mean follow-up was 26 months (95%CI: 20.9-31.6). Mortality during follow-up was of 5.3% (5 respiratory failure, 1 sudden cardiac death, and 2 due to complications of the encephalopathy), 4.2% required re-fundoplication, 15.8% had symptomatic improvement, and 64.0% had absence of symptoms.
  
  
  CONCLUSIONS
  The LNF is an effective technique for the treatment of gastroesophageal reflux, with lower morbidity and shorter hospital stay than CNF. It is recommended as the first surgical option.
authors.affiliation: UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España. Electronic address: josue185@gmail.com.
authors.forename: Josué Eduardo
authors.initials: JE
authors.lastname: Betancourth-Alvarenga
authors.affiliation: UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Garrido Pérez
authors.affiliation: UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Aurora Lucía
authors.initials: AL
authors.lastname: Castillo Fernández
authors.affiliation: UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Murcia Pascual
authors.affiliation: UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Cárdenas Elias
authors.affiliation: UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Escassi Gil
authors.affiliation: UGC Cirugía Pediátrica, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Paredes-Esteban
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies
keywords: Acute life-threatening event; Episodio aparentemente letal; Funduplicatura de Nissen; Gastroesophageal reflux; Hernia de hiato; Hiatal hernia; Nissen fundoplication; Reflujo gastroesofágico