Pediatric Surgery International
Outcomes of laparoscopic nissen fundoplications in children younger
than 2-years: single institution experience
· Jill Whitehouse
· Carrie Laituri
· Glenda Herbello
· Julie Long
Accepted: 14 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Variation exists in the diagnostic testing for gastroesophageal reﬂux (GER) in infants and in the application
of surgical therapy. There has been an increase in antireﬂux surgery (ARS) since the development of laparoscopy but the
outcomes in high-risk infants is unclear. This study examines the results of laparoscopic fundoplication in infants less than
Methods The results of infants less than 2 years undergoing laparoscopic Nissen fundoplication (Lap-F) from 2012 to 2015
were retrospectively reviewed and outcomes were followed until 2017.
Results There were 106 patients, median gestational age 32.50 weeks ± 6.35 SD and non-corrected age at operation
23.0 weeks ± 19.0 SD, mean weight of 4.81 kg ± 2.10 SD. One of the most common reasons for surgical consultation was
improvement in respiratory status after insertion of nasoduodenal feeding tube. Of the Lap-F, 100 were with gastrostomy
tube (GT). There were no conversions to open or intraoperative complications. The complication rate was 4.71%, and the
reoperation rate was 5.66%, one fundoplication revision and the others gastrostomy revisions. The median time for feeds and
to reach goal were 1 (1–14) and 4 (2–279) days, respectively. The 30-day mortality was 0.9% and long-term it was 4.71%.
The long-term mortality was related to the underlying medical problems. The median follow-up was 113 (3–286) weeks.
One patient required revision of the fundoplication and none required esophageal dilatation during the follow-up period.
Conclusion Fundoplication is eﬀective for relief of symptoms of GER in children younger than 2 years. The procedure has
a low morbidity and mortality in this population.
Keywords Laparoscopic · Nissen · Fundoplication · Gastroesophageal reﬂux
Gastroesophageal reﬂux (GER) is considered normal in
infancy. It can be diﬃcult and subjective to determine when
to diagnosis gastroesophageal reﬂux disease (GERD) in an
infant. When GER impacts the child’s health, the diagnosis
of GERD is made. In an infant with multiple medical prob-
lems it is particularly challenging to determine if GER is
exacerbating underlying medical conditions. The underly-
ing medical conditions and the treatment of these problems
can also exacerbate the GER. The threshold for medical
treatment of GERD varies between individual providers
and institutions. There is greater institutional variation in
surgical intervention for GERD. Diagnostic tests for GER
are less accurate in infants and fail to distinguish between
GER and GERD . Besides regional variation in practice,
the diﬃculty in accurately diagnosing reﬂux in infants is
considerable. PH probe is considered the “gold standard” for
Project presented: World Federation of Associations of Pediatric
Surgeons (WOFAPS) 2016 in Washington, DC.
* Julie Long
Department of Surgery, Cleveland Clinic Florida, Weston,
Department of Pediatric Surgery, Joe DiMaggio Children’s
Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL 33021,