Results of laparoscopic antireflux procedures in neurologically normal infants and children.

Most children treated for gastroesophageal reflux have been neurologically impaired. With the recent growth of laparoscopic surgery, neurologically normal children are being referred for fundoplication. We review the presentation diagnostic workup and surgical therapy for children with gastroesophageal reflux unresponsive to medical management. Although many techniques are available for surgical correction of gastroesophageal reflux in children, the laparoscopic Nissen fundoplication remains the standard for correction of gastroesophageal reflux. The technique is performed through five trocars, and emphasis is placed on obtaining at least 3 cm of intra-abdominal esophagus and holding the esophagus in this position with sutures between the crura and the esophagus. The fundoplication should be loose and no longer than 2 cm in length. Long-term follow-up has shown recurrence to be low in children who are neurologically normal as long as they do not gag and retch recurrently.