LAPAROSCOPIC NISSEN FUNDOPLICATION IN DISABLED INFANTS AND CHILDREN

During a 16-month period, 15 neurologically impaired infants and child ren for whom medical treatment failed underwent laparoscopic fundoplic ation. The indications for surgery included feeding difficulties, vomi ting, and recurrent chest aspiration. The patients' weight range was 3 .9 to 42 kg (6 weighed less than 12 kg). Access was modified according to each patient's size and shape. The average operating time was 2.2 hours (range, 1.4 to 3) for fundoplication and 3.1 hours (range, 2.3 t o 4.1) for fundoplication with gastrostomy. Two patients had conversio n to open surgery because of hypercarbia or perforated oesophagus. Use of postoperative analgesia was limited to the first 24 hours, and flu id intake and feeding were begun on days 1 and 2, respectively. Gas bl oating was common postoperatively, and diarrhoea developed in three ch ildren. Twelve patients had clinical improvement, and a recurrent hiat us hernia developed in one. Laparoscopic fundoplication can be success ful; however, awareness of the differences in technique for paediatric (disabled children in particular) and adult patients is essential. Th e technique deserves further investigation. (C) 1996 by W.B. Saunders Company