Laparoscopic vs open approach for the treatment of gastroesophageal reflux in children

Background: The laparoscopic approach has become increasingly popular for fundoplication over the last few years; however many surgeons are skeptical about its real advantages. Methods: We conducted a prospective comparative study of children operated on for gastroesophageal reflux (GER). Exclusion criteria included age < 1 year and > 14 years, previous surgery on the esophagus or stomach, and neurologic impairment. We compared two groups of patients who met the same inclusion/exclusion criteria. One group was treated via a laparotomic approach between January 1993 and December 1997; the other was treated via a laparoscopic approach between September 1998 and December 2000. A 360degrees wrap was performed in each group. Results., Group I (laparotomic approach) included 17 patients; mean operative time was 100 min and postoperative time was 7 days. Group 2 comprised 49 children operated on via a laparoscopic approach, mean operative time was 78 min and postoperative time was 48 hours. No major complications were encountered in either group. In postoperative period. two patients in group I had complications. One had a prolonged bout of gastroplegia, which required nasogastric drainage, and then recovered spontaneously after 20 days, the other had stenosis of the wrap, which required dilation. No relapses occurred during a follow-up of 6 months. Longterm follow-up data are not presented. Comparative analysis of the short-term functional results indicated that there were no differences between the two groups. Conclusion: This study confirms that the minimally invasive approach is safe and effective for the treatment of primary gastroesophageal reflux disease in children.