Background: The aim of this study was to assess the complications associate
d with the laparoscopic treatment of gastroesophageal reflux disease (GERD)
in children.
Methods: From March 1992 to March 1998, we used the laparoscopic approach t
o treat 289 children affected by gastroesophageal reflux disease, The patie
nts' ages ranged between 4 months and 17 years (median, 4.3 years), and the
ir body weight ranged between 5 and 52 kg. In 148 children (51.3%), we adop
ted a Nissen-Rossetti procedure and in 141 (48.7%) a Toupet technique.
Results: The duration of surgery ranged between 40 and 180 min (median, 70)
, There were no deaths and no anesthesiological complications in our series
; We recorded 15 (5.1%) intraoperative complications: six pleural perforati
ons, four lesions of the posterior vagus nerve, two esophageal perforations
, two gastric perforations, and one pericardiac perforation. Conversion to
open surgery was necessary in only four cases (1.3%). We recorded 10 (3.4%)
postoperative complications: one peritonitis due to an esophageal perforat
ion not detected during the intervention that required a reoperation, five
cases of herniation of the epiploon through a trocar orifice, three cases o
f dysphagia that disappeared spontaneously after a few months, and one case
of delayed gastric emptying that subsequently required a pyloroplasty. We
had six recurrences of GERD (2.1%). In two cases, a new fundoplication was
performed using the laparoscopic approach; in the other four, the GERD was
controlled with medical therapy.
Conclusion: Our results show that laparoscopic fundoplication is an adequat
e treatment for children with GERD that has a low rate of complications. Wh
en severe complications do occur, they can be treated effectively via the l
aparoscopic approach.