Goede resultaten van laparoscopische fundoplicatie volgens Thal als behandeling van gastro-oesofageale reflux bij kinderen

Evaluation of the results of laparoscopic fundoplication according to Thal as a treatment for gastro-oesophageal reflux in children.

Design

Prospective, descriptive.

Setting

Department of paediatric surgery, Wilhelmina Children's Hospital, Utrecht, the Netherlands.

Methods

Between November 1993 and May 1996, 53 children with reflux and an average age of 6 years underwent laparoscopic fundoplication according to Thal; in 23 of them a gastrostomy was created as well. The most important symptoms were vomiting and lack of growth. There were 18 children with primary reflux and 35 with secondary reflux, 28 of whom had psychomotor retardation. Preoperatively all patients were subjected to 24-hour oesophageal pH-monitoring, upper GI series and oesophagogastroscopy. Pathological reflux was defined as a pH < 4 during 5 or more of the total time measured (24 hours). pH-monitoring was repeated three months postoperatively to evaluate the effect of the fundoplication and esophagogastroscopy was repeated in case of preoperative oesophagitis.

Results

In one patient the laparoscopic approach was converted peroperatively because of bleeding that had stopped on exploration. Enteral feeding could be recommenced on day one in 49 of 53 children. The mean hospitalisation time was 4.4 days. One patient was reoperated for a too tight fundoplication and two patients died of unrelated causes. The mean follow-up period for the other 50 patients was 11 months (1-35). On follow-up, 42 of them (84) were free of symptoms, while 31 of 41 children (76) in whom pH-monitoring could be done 3 months postoperatively displayed no recurrence of pathological reflux.

Conclusion

Thal fundoplication can be performed laparoscopically in children. Enteral feeding becomes possible again quickly and the period of hospitalisation is short.