Laparoscopic "TOUSSEN" fundoplication for pediatric gastroesophageal reflux disease: a new modified technique gentle as Toupet and solid as Nissen?

AimsExisting fundoplication techniques, although effective, may present drawbacks as dysphagia and recurrence. This study presents a new modified Laparoscopic Toussen (TOUpet-niSSEN) Fundoplication (LTF) developed to reduce the risk of dysphagia and recurrence. We aim to report its safety, feasibility and efficacy in the treatment of pediatric Gastroesophageal Reflux Disease (GERD).MethodsA retrospective study was performed on the clinical data, surgical procedures, and follow-up of a cohort of consecutive patients who received LTF at our tertiary center from 2010 to 2023. The LTF combines a 270 degrees Toupet valve at the upper section and a 360 degrees Nissen valve at the lower section. The exclusion criteria encompassed age over 18 years and patients referred for a redo fundoplication. The diagnosis was based on symptoms and radiological/additional exams, corroborated by a multidisciplinary meeting.ResultsOver a span of 13 years, we treated 219 patients (average of 16 LTF each year), including 49 (22%) with neurological impairment and 13 (6%) with esophageal atresia. The median age at surgery was 5.5 years (range: 1.1-17.5 years), and the median weight 18.2 kg (range: 5.5-80 kg). Gastrostomy was performed in 33 instances (15%). The median duration was 70 min (range: 44 to 177 min). No patient required conversion to laparotomy. Intraoperative problems were observed in 0.4% of patients. During the first postoperative month, 13 early complications occurred (6%): 8 dysphagia, 1 bronchopneumonia, 1 removal of the gastrostomy button, 1 bleeding from trocar orifice, 1 umbilical incisional hernia, and 1 self-limiting neurological symptom. The median duration of hospitalization was 2 days (range: 1-45 days). Overall, we monitored 190 patients for at least 6 months, with a median follow-up of 4.5 years (range: 0.6-11 years). Four patients (2%) required additional surgical intervention: two laparoscopic partial valve releases, one redo fundoplication, and one incisional hernia repair.ConclusionsIn this first analysis of the short- and medium-term outcomes, LTF seemed safe and efficacious for the treatment of pediatric GERD.Levels of evidenceIII.