Evaluation of 142 consecutive laparoscopic fundoplications in children: Effects of the learning curve and technical choice

Purpose: This retrospective study describes the 5-year experience of a sing le surgeon with 142 consecutive laparoscopic fundoplications in children an d analyzes the results in terms of the surgeon's teaming curve and the choi ce of technique. Methods: The patients were 44 girls (40%) and 98 boys (60%) with an age ran ge of 3 months to 18 years (mean, 5.35 years). Indications for surgery incl uded medically refractory reflux associated with vomiting, pneumopathy, oto rhinolaryngologic pathology, failure to thrive, esophagitis, apnea and brad ycardia, or anemia. The laparoscopic surgery used 5 trocars of 5 mm or 3 mm , with a 30 degrees telescope. Results: Laparoscopic fundoplication was successful in 139 cases. The autho rs performed 13 Nissen techniques without short gastric vessel division (SG VD), 47 Toupets without SGVD, 9 Toupets with SGVD, and 70 Nissens with SGVD . Mean operating time was 105 minutes (range, 45 to 300). Mean time was 125 minutes for the first 60 cases and 93 minutes for the other 79 cases). Int raoperative and postoperative complication rates were 0.5% and 2%, respecti vely, and the complications occurred in the first 60 cases. Mean postoperat ive hospital stay was 3 days (range, 2 to 14). Conclusions: The rate of complication caused by the laparoscopic procedure was acceptable, and it decreased with the surgeon's experience. Complicatio ns and conversions to open technique occurred only in the beginning of the operator's experience. Dysphagia, epigastric pain, gas bloating, and early reflux recurrences were noted among the first 60 cases but seemed to be con secutive to the fact that the gastric vessels were not divided. J Pediatr S urg 36:921-926. Copyright (C) 2001 by W.B. Saunders Company.