Surgical treatment of gastroesophageal reflux in severely scoliotic ch
ildren can be quite bothersome because sometimes the working space bet
ween the subcostal margins, iliac crest, and spinal column is very lim
ited; the hiatus lies extremely deep away and is frequently rotated, m
aking exposure more difficult, The laparoscopic approach could lend th
e necessary extension to the surgeons' hands to reach the deep hiatus.
Moreover the entrance of the ports can be adjusted to the special req
uirements dictated by the scoliosis, Between February and December 199
4 laparoscopic Thal fundoplication was performed in five severely scol
iotic children; four also had a feeding gastrostomy, There were no int
raoperative complications, The laparoscopic approach allowed improved
operative visibility. Mean hospital stay was 3 days. The children disp
layed no symptomatic postoperative gastroesophageal reflux, which was
confirmed by 3 months postoperative pH study, The laparoscopic approac
h of fundoplication allows improved visibility and easier access to th
e hiatus in severely scoliotic patients in comparison to the open appr
oach, Results so far are good.