Laparoscopic antireflux surgery in children An analysis of 20 patients

Aim To study the efficacy and feasibility of laparoscopic antireflux surgery in children.Settings and design Descriptive study Materials and methods Twenty one patients between 3 months and 12 years (mean 4.3years), weighing 2.8 Kg to 40 Kg (average 13 Kg) underwent laparoscopic Nissen fundoplication with or without laparoscopy assisted feeding gastrostomy between 2009 and 2011. The indications for surgery were persistent symptoms despite adequate medical treatment or complicated reflux disease. Eight children were neurologically impaired. The other symptoms from the reflux included recurrent respiratory infection (n17), failure to thrive (n12) and vomiting (n4). Five children were being treated for respiratory illness when GER was diagnosed. All patients were diagnosed by a barium swallow preoperatively. All but one patient were given a three month trial of medical therapy.Fifteen patients had Nissen fundoplication alone and six had additional laparoscopically assisted feeding gastrostomy. Conversion to open surgery was necessary in one patient due to dilated bowel loops impairing vision. Fifteen patients had good symptomatic relief. The complications include transient dysphagia (n1), transient vomiting (n1), persistent vomiting (n1), persistent dysphagia (n1), duodenal blow out during gastrostomy change (n1). Two patients died one from a missed ileal perforation and the other three weeks after surgery due to an unrelated cause. Conclusions Laparoscopic Nissen fundoplication in children shows a good overall success rate (80) in terms of complete relief of symptoms. It confers a definite pulmonary advantage over open surgery in neurologically impaired children and in children with respiratory involvement.