Laparoscopic fundoplication in neonates and young infants: Failure rate and need for redo at a high-volume center

Infographic · Dec 2018 · 1 min read

In brief

This high-volume center study of 458 infants under 2 years found a 2.6% failure rate for laparoscopic fundoplication, significantly lower than published rates, with all failures due to wrap migration. The low conversion rate (0.87%) and superior outcomes compared to reported literature suggest surgeon volume and experience are critical factors in pediatric fundoplication success.

Laparoscopic fundoplication in infants <2 years had a 2.6% failure rate (12/458) at this high-volume center, lower than many published series
All 12 failures were due to fundoplication migration, occurring at median 13 months post-op; none occurred in contemporaneous open cases
Nissen fundoplication had highest failure rate (11/360, 3.1%) compared to Toupet (1/77, 1.3%) and Thal (0/21, 0%)
Conversion to open surgery was rare (0.87%), suggesting technical feasibility of laparoscopic approach even in very young infants
Surgeon case volume may be critical factor in achieving low failure rates for this technically demanding procedure in neonates

Written by the GCMD Library team from the infographic.

The infographic uses a light blue color scheme with a monitor illustration showing a stomach diagram in the upper right. The left side features a large circular chart displaying the overall failure rate, while the right side presents three columns comparing outcomes for different surgical techniques. The design is clean and clinical, using sans-serif typography.

Abstract

Aim of the study

Present the outcomes of patients younger than 2 years who underwent laparoscopic fundoplication, highlighting the failure rate and need for redo fundoplication.

Methods

Retrospective review of patients <2 years who underwent laparoscopic fundoplication between January 2009 and December 2014.

Main results

458 infants younger than 2 years underwent laparoscopic fundoplication in the 6-year period (360 Nissen, 77 Toupet and 21 Thal fundoplications). Median age at surgery was 5 (1–23) months. Median follow-up was 3 (1–6) years. The conversion rate was 0.87% (4 of 458 cases). Patients did not undergo routine studies to assess the incidence of postoperative GER but were instead followed clinically. Failure of the fundoplication was determined when a patient was unable to gain weight and/or protect the airway while receiving gastric feedings because of GER. The failure rate in our experience was 2.6% (12 redo out of 458 cases [11/360 Nissen, 1/77 Toupet and 0/21 Thal]). All failed cases occurred because of migration of the fundoplication, confirmed preoperatively by a contrast study. Median time between the initial fundoplication and the redo was 13 (5–27) months. There were no failures within a contemporaneous group of 101 patients <2 years who underwent open fundoplication.

Conclusion

The need for a redo fundoplication after a laparoscopic fundoplication was an uncommon event in our experience (12 of 458 cases). Our results contrast with published studies that report higher failure rates. Case volume per surgeon may explain in part the dissimilar results among studies.