Laparoscopic refundoplication in children

Background: Gastroesophageal fundoplication currently is one of the three m ost common major operations performed on infants and children by pediatric surgeons in the United States: With the advent of laparoscopic surgery, the number of gastroesophageal fundoplications has virtually exploded. Morbidi ty always was substantial with this operation, and laparoscopy has not chan ged this. We describe our results with laparoscopic refundoplication in inf ants and children. Methods: From December 1993 to December 1998 100 children underwent a lapar oscopic 180 degrees anterior wrap using the Thal procedure. Four children h ad to undergo a laparoscopic refundoplication. Two of these children were m entally handicapped. All of the children had recurrent symptoms, but only t wo of the four had an abnormal pH study. In three of the children, the Thal procedure was changed to a Nissen (n = 2) and Toupet (n = 1) fundoplicatio n. One child with an intrathoracic wrap and a giant hiatal hernia underwent hernia repair with a Goretex patch and a redo-Thal. Results: In two of the children, the operation was relatively simple. For o ne child, the procedure had to be converted for anesthesiologic reasons. Th e procedure in the fourth child was more difficult because of a large hiata l hernia. Within a follow-up time of 2 to 4 years, all the children were fr ee of pathologic gastroesophageal reflux symptoms and afterward displayed n o recurrence. Conclusion: In children, laparoscopic refundoplication after a previous lap aroscopic antireflux Thal procedure is feasible and does not increase morbi dity.