LAPAROSCOPIC FUNDOPLICATION IN CHILDREN - OUR FIRST 30 CASES

We report our experience performing 30 laparoscopic fundoplications in children (24 using the Nissen Rossetti technique and 6 using the Toup et fundoplication). Special instruments adapted to the young children are used: first, a miniature parietal suspender to decrease the intrab dominal pressure and to provide more space; second, a retractable lose nge-shaped liver retractor; and third, a Babcock forceps articulated a t 60 degrees. In the Nissen Rossetti procedure, the wrap is fixed to t he anterior face of the esophagus, the anterior wall of the fundus, an d the upper right crus. In the Toupet procedure, the wrap is a retroes ophageal partial fundoplication: the first suture attaches the wrap to the right crus, the second attaches the wrap to the esophagus, and th e third recreates the oesogastric angle. We do not use gastrostomy. Pa tients have no gastric tube after the intervention. Thirty children fr om 2 to 15 years have undergone laparoscopic fundoplications. One conv ersion to open procedure was necessary. An average follow-up of 12 mon ths was observed for 18 children with 3 complications: dysphagia for a psychotic girl, intrathoracic valve without any trouble, and recurren t episodes of digestive bleedings during 6 months. Laparoscopic fundop lication is a feasible extension of minimally invasive surgery in the hands of experienced surgeons; however limitations must be recognized to do a safe operation.