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

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Abstract
The laparoscopic approach has become increasingly popular for fundoplication over the last few years; however many surgeons are skeptical about its real advantages. We conducted a prospective comparative study of children operated on for gastroesophageal reflux (GER). Exclusion criteria included age 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 360° wrap was performed in each group. Group 1 (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 1 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. This study confirms that the minimally invasive approach is safe and effective for the treatment of primary gastroesophageal reflux disease in children.