Laparoscopic Toupet fundoplication for gastroesophageal reflux: a series of 131 neurologically impaired pediatric cases at a single children’s hospital

Abstract

Our LTF would appear to be safe for treating GERD in children because of reliable outcome and low recurrence.

Risk Factors for Incisional Hernia in Children

“…Furthermore, the current study demonstrated that laparoscopic fundoplication is one of the risk factors for IH. The additional reports that followed showed an overall incidence of 0–3%; however, there are few reports of children case [7–10]. Our three cases of IH after laparoscopic fundoplication were neurologically impaired children.…”

A comparison of laparoscopic redo fundoplications for failed toupet and nissen fundoplications in children

“…We are of the opinion that the denser adhesions observed at R-LNF may have some relationship to belching because accumulated air in the stomach will stress the initial fundoplication causing inflammation that could progress to adhesion formation. [15] Double suturing at the fundoplication site during LTF could also stabilize the hiatus and minimize inflammation and adhesions.…”

“…We prefer to be more conservative and perform conventional dissection and mobilization of the crura and esophagus because we are familiar with the outcome in both neurologically normal and impaired children. [1518] However, as more cases are treated minimally, a comparison of redos after conventional and minimal surgical intervention may become necessary. At present, we have no plan to change our orthodox approach.…”

Comparison of laparoscopic Toupet and laparoscopic Nissen fundoplications in neurologically normal children

“…We previously reported a relatively low recurrence rate after GER surgery involving similarly extensive dissection in neurologically impaired children . Although our current series of neurologically normal cases is small compared with adult series in the literature , we believe the common training programs at both centers are consistent enough to minimize technical bias.…”

“…Although the difference in recurrence between the two groups was not statistically significant, we hypothesize that belching may be implicated because it eases the urge to cough. Thus, there may be less pressure buildup around the operative site after LTF, which helps prevent suture dehiscence and slipping that could cause recurrence of GER . With this in mind, we also prefer to delay the recommencement of enteral feeding at both our centers to prevent extra physical stress on the operative site.…”