That’s a wrap: a 7-year case series of paediatric laparoscopic Nissen’s fundoplication

• Published in: Journal of pediatric endoscopic surgery 2024-03, Vol.6 (1), p.21-24
• Main Authors: Abdelbary, Mahmoud, Berezowska, Aleksandra, Cao, Kevin, Jawaid, Wajid, Aslam, Adil
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Original Research; Pediatric Surgery; Surgery; Thoracic Surgery
• ISSN: 2524-7875; 2524-7883
• DOI: 10.1007/s42804-024-00218-y

Introduction We present herein a 7-year single-surgeon case series describing the experience and learning from managing paediatric gastro-oesophageal reflux disease (GORD) and the laparoscopic Nissen’s fundoplication (LNF) procedure. Methods Retrospectively, data encompassing all patients subjected to LNF from 2014 to 2021 was compiled. Our surgical paradigm centred on optimising restrained dissection at the diaphragmatic hiatus and a lax gastric wrap. Patient demographics, preoperative medical particulars, investigative findings, and postoperative outcomes were systematically collected to facilitate subsequent analysis. Results Across the study’s duration, 43 laparoscopic Nissen’s fundoplication were completed. Operative time reduced from 121 min in the first 10 cases to 69 min in the final 10 cases reflecting a learning curve. A total of six cases were converted to open fundoplication (14%). In our cohort, 2 patients required redo operations for technical failure, one was operated on at another centre (5%), 28 patients had resolution of symptoms with surgery alone (65%), one improved with further dilatation (2%) and 14 improved with additional medical therapy (32%), including prokinetics and antihistamines. In this cohort, ten patients had concomitant neurological diagnosis, with five improving post-fundoplication, four improving with pharmacological treatment and one after redo-surgery. Discussion Our series highlights 7 years of a surgeon’s progression in their technical proficiency with GORD surgery, showing the learning curve for this surgery. This was evident in shortening of operative times. More importantly, careful patient selection led to clinical resolution of symptoms in many cases (89.1%). We share this clinical journey, along with insightful video supplements, offering learning points for aspiring minimally invasive surgeons. These insights lay the groundwork for the next generation, dedicated to improving the lives of children with GORD.