Laparoscopic surgery for gastroesophageal reflux disease during the first year of life

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.