ReviewsLaparoscopic redo fundoplication in children: Failure causes and feasibility
Section snippets
Patients and methods
From August 1993 to February 2005, 417 children were operated on for GER in our unit using the laparoscopic approach. There were 152 girls and 265 boys with a mean age of 57 months (from 1 month to 17 years). One hundred forty-nine (36%) of them were NI; 88 (21%) of them presented a significant malnutrition and an indication to place a feeding gastrostomy within the antireflux intervention.
Surgical indication was a GERD either with a resistance to medical treatment or with a life-threatening
Failure rate
Four hundred seventeen children underwent laparoscopic surgery for GERD. Thirty of them had to be reoperated on for recurrence symptoms; the global rate of failure was 7.19%.
The previous procedures used in these patients were 13 (4.7%) Nissen, 10 Toupet (14%), and 7 (10.3%) Nissen-Rossetti. The mean age of patients at the time of redo surgery was 57.6 months old (48-204 months). There was a predominance of boys—19 patients (63%)—and 11 girls (31%).
The mean delay between the initial procedures
Discussion
Laparoscopic fundoplication is successful in preventing reflux in more than 95% of patients. However, over time, there appears to be failure of the fundoplication, which is unlikely that medical management will be successful in controlling the reflux symptoms after either wrap breakdown and/or transmigration. Thus, operative repair for control of recurrent symptoms is required in most cases [14].
Large series of laparoscopic antireflux procedures have included some patients with adverse outcome
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Cited by (39)
Short and long-term outcomes after pediatric redo fundoplication
2022, Journal of Pediatric SurgeryCitation Excerpt :Thus, our finding of recurrent GERD in 21% is comparable to what has been reported earlier. Only one patient in our study underwent a re-RF (4%), reflecting previous findings of re-RF in 6–26% of patients [7–12]. Many pediatricians and pediatric surgeons assume that the success rate is considerably lower after RF than after primary fundoplication [9,10,20].
Error traps and safety steps when performing a laparoscopic Nissen fundoplication
2019, Seminars in Pediatric SurgeryCitation Excerpt :We feel that failure to ligate and divide the short gastric vessels (the Rosetti modification) leads to excessive tension on the subsequent fundoplication wrap, and this tension can lead to dysphagia with obstruction to solid foods postoperatively. Several surgeons have described transitioning from the Rosetti modification to ligation and division of the short gastric vessels because of an increased incidence of dysphagia with the Rosetti modification.6–10 Although some surgeons believe that leaving the short gastric vessels intact saves operative time, we find that ligation and division of these vessels in infants and young children takes less than 5 min in most cases (Fig. 1A).
Impact of Esophageal Atresia on the Success of Fundoplication for Gastroesophageal Reflux
2018, Journal of PediatricsCitation Excerpt :Redo fundoplication was used as a surrogate marker for surgical failure, in preference to postoperative pH studies, upper gastrointestinal contrast studies, and symptom recurrence, as the use and interpretation of these alternative markers were variable in our cohort, and so open to biases. Redo fundoplication is acknowledged to be subject to biases, albeit its use is consistent with previous studies of this kind in adults7,8 and children.9-13 Indication for surgery and details regarding antireflux medications were inconsistently recorded and so were not specifically reviewed.
Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review
2017, Journal of Pediatric SurgeryCitation Excerpt :Given these limitations, we attempted to group the papers by operation type and outcome measure for the purposes of this review. In total, eighteen retrospective studies examined pediatric outcomes after Nissen fundoplication for the majority of procedures (either open or laparoscopic) with well-defined outcome measures and a follow-up time of two or more years [9,65–81]. The populations were heterogeneous, with most studies using a mix of NI and neurologically normal patients, a variety of modalities to diagnosis GERD, and different primary outcome measured.
Gastroesophageal reflux disease in children
2016, Seminars in Pediatric Surgery