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Laparoscopic gastric fundoplication in children under 6 kg: As well as in older children?

Vladimir Gomola, Jerome Viala, Philippe Sachs, Sophie Soudée, Alaa El Ghoneimi, Arnaud Bonnard

Robert Debré Children University Hospital, Paris, France

 

Abstract 

Purpose of the study: To describe our experience and the results of laparoscopic gastric fundoplication (LGF) in children less than 6kg.
Patients and Methods: All cases of LGF performed in children under 6 kg were retrospectively reviewed. The procedure was a Nissen fundoplication without release of short vessels. Gastroesophageal reflux disease (GERD) resistant to an optimal medical management with respiratory symptoms and/or failure to thrive was the indication for surgery. The primary endpoint was recurrence of reflux defined by the reappearance of clinical signs of GERD and / or indirect symptoms improved by the PPIs.
Results: Twenty patients were reviewed. The mean birth weight was 2581 +/- 824 grams. Six patients were neurologically impaired. Eleven patients have associated comorbidities. The average age at surgery was 4.6 +/- 1.65 months and the average weight of 4724 +/- 1053 grams.
Twelve gastrostomies were performed at the same time. The mean operative time was 82 +/-38 minutes. There was no conversion. Fourteen patients were cared for in the ICU and extubated on day 0. Two patients were reintubated for respiratory distress. The average hospital stay was 39 days (6-151 days). Two patients died (10%) independently from the surgery. The mean follow-up was 24.5 +/-13.2 months. Seven patients (37%) presented with a recurrence of the GER, 2 requiring a redo laparoscopic Nissen fundoplication.
Conclusion: FGL in less than 6kg is technically feasible, but the failure rate is high. However, it can help to pass a course in some children with comorbidities and redo surgery is not necessary in these patients.