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. 2019 Apr-Jun;24(2):100-103.
doi: 10.4103/jiaps.JIAPS_228_17.

A Comparison of Laparoscopic Redo Fundoplications for Failed Toupet and Nissen Fundoplications in Children

Go Miyano  1   2 , Masaya Yamoto  1 , Hiromu Miyake  1 , Keiichi Morita  1 , Masakatsu Kaneshiro  1 , Hiroshi Nouso  1 , Mariko Koyama  1 , Manabu Okawada  2 , Takashi Doi  2 , Hiroyuki Koga  2 , Geoffrey J Lane  2 , Koji Fukumoto  1 , Atsuyuki Yamataka  2 , Naoto Urushihara  1
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A Comparison of Laparoscopic Redo Fundoplications for Failed Toupet and Nissen Fundoplications in Children

Go Miyano et al. J Indian Assoc Pediatr Surg. 2019 Apr-Jun.

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.

Keywords: Nissen fundoplication; Toupet fundoplication; redo fundoplication.

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Conflict of interest statement

There are no conflicts of interest.

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