Laparoscopic fundoplication in neonates and young infants: Failure rate and need for redo at a high-volume center
Topic overview
Retrospective study of 458 infants under 2 years who underwent laparoscopic fundoplication shows a low failure rate of 2.6% requiring redo surgery, primarily due to wrap migration. Results suggest high surgeon volume may contribute to better outcomes compared to published literature reporting higher failure rates.
Key takeaways
- Laparoscopic fundoplication in infants <2 years had a 2.6% failure rate (12/458) at this high-volume center over 6 years.
- All failures were due to fundoplication migration, occurring at median 13 months post-op; no failures in concurrent open cases.
- Nissen had highest failure rate (11/360) vs Toupet (1/77) and Thal (0/21); conversion to open was rare at 0.87%.
- Surgeon case volume may explain lower failure rates compared to published literature reporting higher redo rates.
- Clinical follow-up rather than routine imaging was used; failure defined as inability to gain weight or protect airway on gastric feeds.
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