Complications of laparoscopic antireflux surgery in childhood

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.