| ORIGINAL ARTICLE
|Year : 2019 | Volume
| Issue : 2 | Page : 100-103
A comparison of laparoscopic redo fundoplications for failed toupet and nissen fundoplications in children
Go Miyano1, Masaya Yamoto2, Hiromu Miyake2, Keiichi Morita2, Masakatsu Kaneshiro2, Hiroshi Nouso2, Mariko Koyama2, Manabu Okawada3, Takashi Doi3, Hiroyuki Koga3, Geoffrey J Lane3, Koji Fukumoto2, Atsuyuki Yamataka3, Naoto Urushihara2
1 Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka; Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
2 Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
3 Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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.
Dr. Go Miyano
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421
Source of Support: None, Conflict of Interest: None
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