FUNCTIONAL RESULTS OF LAPAROSCOPIC FUNDOPLICATION IN CHILDREN

Background: There is no evidence that the results of laparoscopic fund oplication in children match those of the open procedure. In the curre nt report, pre-and postoperative function of the antireflux barrier is examined in children having laparoscopic fundoplication for gastroeso phageal reflux. Methods: Twenty-seven patients with gastroesophageal r eflux, aged 7.2 +/- 4.5 years, were operated on for unremitting gastro intestinal symptoms (n = 24), with respiratory tract disease (n = 11), cystic fibrosis (n = 2), or brain damage (n = 11). Gastrostomy was ad ded in 5 cases. Barium contrast study, pH-metering, endoscopic examina tion, and biopsy were performed before and after a median of 19 months (range, 8 to 46) after operation. Results: At diagnosis, 15 of 21 pat ients had esophagitis that was moderate or severe in 11 (1 with Barret t's esophagus). Symptoms disappeared after fundoplication in all but 2 patients, in whom they became milder. The reflux index de creased fro m 20.2 +/- 20% to 4.9 +/- 9% and became normal in all except 4 childre n (2 with brain damage and 1 with cystic fibrosis). Open repair of the failed wrap was considered necessary in only 1 of them. Conclusions: Laparoscopic fundoplication is as effective as the open procedure (14% overall failure rate). However, the failure rate in neurologic patien ts (18%) suggests that before reaching conclusions on the benefits of this approach, careful long-term assessment of the functional results is necessary. (C) 1998 Lippincott-Raven Publishers.