Background: Very few children need gastroesophageal antireflux surgery duri
ng their first year of life; hence, no series has been published so far. Th
e authors report their experience in 3 centers,
Methods: From January 1993 to December 1998, 36 infants between 23 days and
13 months of age, suffering from gastroesophageal reflux disease (GERD), u
nderwent surgery by a laparoscopic approach. The patients' weights ranged f
rom 2.4 to 8.5 kg. Preoperative diagnostic studies included esophagograms,
manometries, endoscopies, and pH-metries. Fifteen babies (41.6%) had associ
ated anomalies, and 10 (27.7%) were neurologically impaired. Thirty-six lap
aroscopic fundoplications were performed according to either Toupet's proce
dure (17 of 36), Rossetti's (10 of 36), Nissen's (8 of 36) or Lortat-Jacob'
s (1 of 36). Four infants previously had undergone a gastrostomy, whereas 6
needed one during the antireflux procedure.
Results: There was no mortality in our series. Three infants (8.3%) had an
intraoperative complication: 1 lesion of a diaphragmatic vessel, 1 pneumoth
orax, and 1 case of severe hiatal hernia requiring conversion to open surge
ry. During the median follow-up of 22 months, 4 redo procedures were perfor
med (11.1%).
Conclusions: This experience shows the feasibility of laparoscopic fundopli
cation even in children below 1 year of age. An accurate preoperative diagn
ostic study is mandatory, because 50% of these patients presented associate
d anomalies. A long and accurate follow-up is necessary to evaluate long-te
rm results and detect possible complications, which can occur as late as 1
year after surgery. In addition, we believe that redo antireflux surgery is
possible by the laparoscopic approach without major difficulties, based on
our larger experience with older children. J Pediatr Surg 36:715-717. Copy
right (C) 2001 by W.B. Saunders Company.