A 15-year experience in laparoscopic surgery for gastroesophageal reflux in children

Aims: for 15 yrs, operative methods have moved from open to videoscopic surgery, especially for gastro-esophageal reflux (GER), as quoted in this pediatric series. Patients and method: from Feb 1992 to June 2006, we applied laparoscopic surgery to 1017 Toupet's procedures in children, aged 5 ms to 17 yrs (mean 3.4). Their GER were severe and not cured by medical treatment. Among them, 15% were neurologically impaired. Preoperative workup included also manometric studies in 91% of cases. The followup was routinely extended to 5 yrs. Results: in this series, there were no mortalities, no conversions, no anaesthetic complications. Surgical complications (1.1%) were 1 gastric perforation, 3 pneumothorax, 2 tears of the posterior vagus nerve, 3 omentum evisceration, 2 shots of the NGtube by a stitch and 1 severe pneumonia at D8. Among 1.9% of recurrences, 9 needed a redo. GER disappeared in all cases, 508 patients passed the 5 yrs point. Discussion: complications and recurrences were rare. Many technical details have been focused through the expertise. Good results obtained with Toupet's technique have emphasized our preference for it. Stenosis and dysphagia seem better avoided. Conclusion: laparoscopic surgery applied to children is safe whatever the age. A true information has to be delivered to parents and paediatricians. Their confidence has been acquired from this series.