Day-case laparoscopic Nissen fundoplication in children.

BACKGROUND

The aim of this study was to assess the acceptability and safety of day-case laparoscopic Nissen fundoplication for gastroesophageal reflux disease in children.

METHODS

All children who underwent a laparoscopic Nissen fundoplication procedure were analyzed retrospectively, and the cases who had day surgery were selected over a 2-year period (May 2003-August 2005). All patients had proven symptomatic reflux disease. Inclusion criteria were that children were over 6 months of age and had a American Society of Anesthesiologists grade I or II with acceptable home support. A standard anesthetic, analgesic protocol was used. Caregivers were contacted by telephone on the night of discharge and on the following morning; all patients were seen at 1 week and 6 months postoperatively.

RESULTS

In the study period, 68 children underwent a laparoscopic Nissen fundoplication procedure performed by the first author. Twenty-one (21) children were suitable for day-case surgery, and all procedures were performed as the first case on an elective list. Postoperatively, all but 2 patients were discharged on the afternoon of the surgery. Time to discharge was 6 hours 30 minutes (range, 5-8 hours). No patient required a readmission. There was minimal pain, but no nausea, in the evening following the surgery; pain responded effectively to standard oral analgesia. All caregivers were satisfied with the information given and aftercare provided. All caregivers would recommend the procedure to other caregivers and all would allow for their children to undergo the procedure as a day case again. There have been no cases of recurrent symptoms in the 6-month follow-up period.

CONCLUSIONS

This paper is the first report in the pediatric literature to suggest that day-case laparoscopic fundoplication is feasible in children. Patients and caregivers find the procedure acceptable and it appears to be safe.