Evolution of the modified Rossetti fundoplication in children - Surgical technique and results

Objective To compare the modified Rossetti fundoplication with the classic Nissen. Summary Background Data The traditional surgical treatment of gastroesophag eal reflux in children has been the classic Nissen fundoplication, defined by liver mobilization, crural repair, takedown of short gastric vessels, an d floppy wrap. The authors have progressed in our technique of fundoplicati on and now perform a modified Rossetti fundoplication, defined by liver ret raction without mobilization, no crural repair, short gastric vessels left intact, and 2-cm floppy wrap. Methods A retrospective chart review was performed on 407 pediatric patient s who had open fundoplications (Jan. 13, 1993, to Feb. 25, 1998). Two group s were analyzed: the Nissen group (171 patients) and the Rossetti group (23 6 patients). Groups were compared for incidence of recurrent reflux, dyspha gia, hiatal hernia, need for esophageal dilation, revision of fundoplicatio n, time to discharge, and operative time. Results Incidence of dysphagia (3.7% vs. 3.3%), postoperative hiatal hernia (1.9% vs. 1.4%), need for esophageal dilation (1.2% vs. 0.5%), and need fo r fundoplication revision (2.5% vs. 2.3%) were similar between the groups. The mean operative time was significantly decreased in the Rossetti group ( 65 +/- 25 minutes) versus the Nissen group (73 +/- 33 minutes). Recurrent r eflux occurred significantly more often in the Nissen group (11.2%)than in the Rossetti group (5.1%). Conclusion The modified Rossetti fundoplication has a low complication rate and is the authors' preferred method for the surgical treatment of gastroe sophageal reflux in children.