A comparison of laparoscopic redo fundoplications for failed toupet and nissen fundoplications in children

Go Miyano, Masaya Yamoto, Hiromu Miyake, Keiichi Morita, Masakatsu Kaneshiro, Hiroshi Nouso, Mariko Koyama, Manabu Okawada, Takashi Doi, Hiroyuki Koga, Geoffrey J. Lane, Koji Fukumoto, Atsuyuki Yamataka, Naoto Urushihara

Research output: Contribution to journalArticle

Abstract

Purpose: We compared laparoscopic redo fundoplications performed for failed laparoscopic Toupet fundoplication (LTF) and failed laparoscopic Nissen fundoplications (LNFs). Methods: Redo LTF (R-LTF; n = 4) and redo LNF (R-LNF; n = 6) performed between 2007 and 2014 were assessed retrospectively for severity of intraperitoneal adhesions on a scale of 0-3, identification/preservation of the anterior/posterior/hepatic branches of the vagus nerve (VN), complications, and outcome. Results: Redos were performed after a mean of 34 months in R-LTF and 32 months in R-LNF (P = ns) indicated for sliding hernia (n = 3; 2 with partial wrap dehiscence) and partial wrap dehiscence (n = 1) in R-LTF and sliding hernia (n = 6; 4 with partial wrap dehiscence) in R-LNF. The mean adhesion severity score was 1.5 in R-LTF and 2.5 in R-LNF (P < 0.05). The mean number of VN branches identified/preserved was 2.0 in R-LTF and 0.8 in R-LNF (P < 0.05). Mean operative times and mean blood loss were similar. Intraoperative complications were accidental local trauma (n = 1 in R-LTF and n = 3 in R-LNF, one requiring conversion to open repair) (P = ns). Gastric outlet obstruction developed in two R-LNF cases; both were managed conservatively. There have been no further recurrences to date. Conclusion: Although our series is small, adhesions were less, and identification/preservation of VN was easier during R-LTF.

Original languageEnglish
Pages (from-to)100-103
Number of pages4
JournalJournal of Indian Association of Pediatric Surgeons
Volume24
Issue number2
DOIs
Publication statusPublished - Apr 1 2019
Externally publishedYes

Keywords

  • Nissen fundoplication
  • redo fundoplication
  • Toupet fundoplication

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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    Miyano, G., Yamoto, M., Miyake, H., Morita, K., Kaneshiro, M., Nouso, H., Koyama, M., Okawada, M., Doi, T., Koga, H., Lane, G. J., Fukumoto, K., Yamataka, A., & Urushihara, N. (2019). A comparison of laparoscopic redo fundoplications for failed toupet and nissen fundoplications in children. Journal of Indian Association of Pediatric Surgeons, 24(2), 100-103. https://doi.org/10.4103/jiaps.JIAPS_228_17