Experience with 220 consecutive laparoscopic Nissen fundoplications in infants and children

Backgroond/Purpose: Fundoplication for gastroesophageal reflux disease is a common procedure performed in infants and children. This report describes a 4-year experience with 220 consecutive laparoscopic Nissen fundoplications. Methods: Ages ranged from 5 days to 18 years and weight from 1.4 to 100 kg. The procedures were performed using a five-trocar technique and with 5- or 3.4-mm instruments depending on the size of the patient. Results: Two hundred eighteen fundoplications were completed successfully. Average operative time dropped dramatically from 109 to 55 minutes for the first 30 cases compared with the last 30, Intraoperative and postoperative complication rates were 2.6% and 7.3%, respectively, Average time to discharge postfundoplication was 1.6 days, The wrap failure rate is 3.4%. Conclusions: This study shows that although the learning curve for laparoscopic fundoplication may be steep, the procedure is safe and effective in the pediatric population. The clinical results are comparable to the traditional open fundoplication but with a significant decrease in morbidity and hospitalization. Copyright (C) 1998 by W.B. Saunders Company.