LAPAROSCOPIC THAL FUNDOPLICATION IN MENTALLY-RETARDED CHILDREN

Background: An increasing number of reports indicate that Tha1 fundopl ication is the procedure of choice in mentally retarded children. With the advent of laparoscopy, Nissen's fundoplication seems to have been repopularized. However, the choice of the operative technique should be based on the merits of the procedure itself rather than the laparos copic feasibility, The aim of this study is to determine if laparoscop ic Tha1 fundoplication is beneficial for mentally retarded children. M ethods: Between November 1993 and 1994 laparoscopic Tha1 fundoplicatio n was performed in 15 mentally handicapped children; 13 also had a fee ding gastrostomy, Age varied from 1.5 to almost 17 years (mean 7 years ). Mean weight was 18 kg (5-50 kg), All patients underwent an upper GI study and endoscopy as well as pre- and 3 months postoperative pH stu dy. Indications for the procedure were reflux esophagitis in 11 and fe eding problems with silent reflux in 4. Results: The laparoscopic proc edure was converted in the second patient because of bleeding in the h iatus. No further procedure-related intra- or postoperative complicati ons occurred. The mean hospitalization was 3.7 days, No symptomatic po stoperative gastroesophageal reflux has been observed, All children ha ve undergone postoperative pH studies, which displayed silent reflux i n two. Gastrostomy feeding is well tolerated. Conclusion: We conclude that Tha1 fundoplication can be performed laparoscopically in mentally retarded children. The laparoscopic results are comparable to the ope n Tha1 procedure.