Aim: Fundoplication is the commonest major laparoscopic procedure in children. The operation has a significant failure rate, but it is unclear whether revisional surgery may be safely performed laparoscopically. The aim of this study is to compare revisional laparoscopic fundoplication with a previous cohort of children undergoing open revisional surgery.
Patients and methods: Twenty children, 10 girls underwent 21 revisional fundoplications performed by one surgeon. Thirteen children, average age 10, underwent laparoscopic revisional fundoplication, while 8, average age 9, underwent laparotomy and revision. No child was converted from laparoscopy to laparotomy. The entire laparotomy group had previously undergone open fundoplication. Ten of the 13 in the laparoscopic group had prior laparoscopic fundoplication, while 3 had undergone open fundoplication. All revisions consisted of take down of all previous surgery, re-exploration of the hiatus with hiatal repair and Nissen fundoplication. Case note review allowed the following data to be compared: duration of surgery, blood loss, morphine administered, hospital stay and complication rate. Data were compared with the Mann-Whitney test and are expressed as medians with 95%confidence intervals, comparison of proportions used χ2 test.
Results:
Laparoscopic |
Open |
|
Duration surgery |
180 min (161 to 258) |
153 min (99 to 208) |
Blood loss |
1.7ml/kg (1 to 5) |
4.4ml/kg (2 to 9) |
Morphine given |
0.28mg/kg (.23 to.85) |
1mg/kg (0 to 3.5) |
Hospital stay |
4d (3 to 6) |
7d (4 to 14) |
There is no statistical difference between the data. Two of the open and 7 of the laparoscopic revisions had minor operative complications, but neither group had a complication delaying discharge.
Conclusions: Fundoplication may be safely revised laparoscopically in children. The small sample size may mask benefits of less pain, blood loss and early discharge for laparoscopic revision.
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