Laparoscopic redo Nissen fundoplication in infants and children

Abstract

From January 1994 to December 2004, 118 patients with recurrent gastroesophageal reflux disease (GERD) after fundoplication underwent laparoscopic redo Nissen fundoplication. The patients ranged in age from 6 months to 19 years (mean, 7 years), and weighed from 6.4 to 85 kg. Of the 118 patients, 64 had previous open fundoplications, 53 had previous laparoscopic fundoplications, and 19 had more than one previous fundoplication. All the procedures had been successfully completed laparoscopically. The average operative time was 100 min. The intraoperative complication rate was 1.1%. The average time to full feeding was 1.8 days, and the average hospital stay was 2.2 days. The postoperative complication rate was 3.6%. The wrap failure rate during an average follow-up period of 48 months was 6%. Laparoscopic redo Nissen fundoplication for a failed antireflux procedure is a safe and effective procedure. It has the same benefits as a primary laparoscopic Nissen for GERD, with low morbidity and a quicker recovery. Early follow-up evaluation suggests that the long-term outcome is superior to that associated with open redo fundoplication.

Minimally invasive surgery in infants less than 5 kg: experience of 649 cases

“…While it is clearly understood that Nissen fundoplications fail more frequently in small children, we believe that often the risk of delaying the operation is greater than the risk of a redo Nissen [47]. In this series, there were no complications from redo Nissens.…”

“…The techniques for fundoplication [4,10,12,47,48], pull-through procedure [13-15, 17, 19, 20, 22, 25, 27, 28, 31, 33, 34], PDA closure [45,46], Ladd's procedure [6][7][8][9], lung biopsy [44], lobectomy [42,43], pyloromyotomy [1][2][3], tracheoesophageal fistula (TEF) repair [21,40,41], and duodenal atresia repair [5] have been previously described in detail. The congenital diaphragmatic hernia repairs were performed with three or four trocars placed in the upper abdomen with repair of the defect using single interrupted braided nonabsorbable sutures.…”

Long-term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children

“…It is likely that early recurrences in this group were due, as in the other group, to technical problems. Therefore, we performed redo Nissen fundoplication, which can safely be performed through the laparoscopic approach [18,19]. With regard to long-term recurrences, we believe they were the consequence of an evolving disease associated with increased spasticity, intestinal dysmotility, and consequently more stress on the wrap, leading to wrap disruption.…”

The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children

“…Since then, Georgeson [15] has performed more than 2,000 fundoplications in infants and children. Rothenberg [30,31] recently reported the results for his series of more than 1,100 cases.…”