ReviewsLaparoscopic redo fundoplication in children: Failure causes and feasibility
Section snippets
Patients and methods
From August 1993 to February 2005, 417 children were operated on for GER in our unit using the laparoscopic approach. There were 152 girls and 265 boys with a mean age of 57 months (from 1 month to 17 years). One hundred forty-nine (36%) of them were NI; 88 (21%) of them presented a significant malnutrition and an indication to place a feeding gastrostomy within the antireflux intervention.
Surgical indication was a GERD either with a resistance to medical treatment or with a life-threatening
Failure rate
Four hundred seventeen children underwent laparoscopic surgery for GERD. Thirty of them had to be reoperated on for recurrence symptoms; the global rate of failure was 7.19%.
The previous procedures used in these patients were 13 (4.7%) Nissen, 10 Toupet (14%), and 7 (10.3%) Nissen-Rossetti. The mean age of patients at the time of redo surgery was 57.6 months old (48-204 months). There was a predominance of boys—19 patients (63%)—and 11 girls (31%).
The mean delay between the initial procedures
Discussion
Laparoscopic fundoplication is successful in preventing reflux in more than 95% of patients. However, over time, there appears to be failure of the fundoplication, which is unlikely that medical management will be successful in controlling the reflux symptoms after either wrap breakdown and/or transmigration. Thus, operative repair for control of recurrent symptoms is required in most cases [14].
Large series of laparoscopic antireflux procedures have included some patients with adverse outcome
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