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Laparoscopic Refundoplication in Childhood (Abstract)

Ciro Esposito¹, Francesca Alicchio¹, Francesco Corcione², Philippe Montupet ³, Alessandro Settimi ²

¹ Chair of Pediatric Surgery, Federico II University, Naples, Italy

² Department of Laparoscopic Surgery, Monaldi Hoispital, Naples, Italy

³ Clinique Chirurgical Boulogne Billancourt, Paris, France

 

Abstract

Background: The aim of this paper was to determine the feasibility of laparoscopic revision surgery in children following previous open and laparoscopic antireflux operations.

Methods: To give an objective overview about this topic we have preferred to analyze the outcome of 15 children (8 girls and 7 boys) who had undergone attempted laparoscopic revision between 4 months and 72 months (median 16 months) after a previous antireflux operation. Seven patients had previously had an open antireflux procedure ( 4 Nissen fundoplication, 3 Thal procedure) and 8 a laparoscopic procedure (5 Nissen; 3 Toupet’s procedure ). Two of these children were mentally handicapped. The indications for revision were: recurrent reflux, 5; valve migration, 5; valve dismount, 5. Eight procedures comprised construction of a new Nissen fundoplication, in 7 cases a Toupet’s procedure was performed.

Results: Revision was successfully completed laparoscopically in 10 cases; 7/8 patients following a previous laparoscopic procedure and in 3/7 following a previous open operation. Operating time ranged between 70 and 140 minutes (med 90 minutes). No perioperative complications occurred in either group.All patients were discharged within 3-4 days after the redo procedure. Follow-up time varied between 6 months- 7 yrs. Preoperative symptoms were relieved in all patients and all antireflux medication have been discontinued, except in two cases that still had rare symptoms .

Conclusions: Although technically challenging, laparoscopic reoperation for recurrent gastroesophageal reflux disease can be performed safely and with good results, in the hands of experienced endoscopic surgeons. Reoperation is likely to be more difficult following failure of an open procedure than a laparoscopic one. Concerning the type of procedure, is more difficult to perform a redo surgery after Nissen’s that after Toupet’s or Thal’s procedure.

Key words: GERD, Redo surgery, laparoscopy, children.

 

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