Skip to main content
SpringerLink
Log in

Laparoscopic Toupet fundoplication for gastroesophageal reflux: a series of 131 neurologically impaired pediatric cases at a single children’s hospital

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

To present the medium to long-term outcome of the largest pediatric series of laparoscopic Toupet fundoplications (LTF) performed at a single institution.

Patients and methods

Subjects were 131 neurologically impaired children (81 M, 50 F) who underwent LTF between 2003 and 2013. Our LTF involves full dissection of the crus of the diaphragm to allow the intraabdominal esophagus to be mobilized at least 3–4 cm.

Results

Preoperative mean fraction time for pH <4 was 14.6 %. Mean age at LTF was 6.7 years (3 months–18 years). Mean duration of follow-up was 5.7 years (range 1.2–12.1 years). One case required conversion to open surgery. Intra-operative complications were all injuries to the esophagus/gastric wall (n = 4; 3.0 %) including full-thickness perforation (n = 1; 0.8 %). Postoperative complications included pyloric stenosis (n = 4; 3.0 %), dysphagia (n = 1; 0.8 %), incisional hernia (n = 1; 0.8 %), hemorrhage requiring transfusion (n = 1; 0.8 %), recurrence (n = 3; 2.3 % at 11, 13, and 48 months, respectively), and gastrostomy site infection (n = 7; 5.3 %). Mean operative time decreased significantly with experience from 180.8 min for the first quarter of subjects to 150.6 (2nd quarter), 128.6 (3rd) and 109.2 min (4th).

Conclusions

Our LTF would appear to be safe for treating GERD in children because of reliable outcome and low recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lobe TE, Schropp KP, Lunsford K (1993) Laparoscopic Nissen fundoplication in childhood. J Pediatr Surg 28(3):358–360 (discussion 360–361)

    Article  CAS  PubMed  Google Scholar 

  2. Georgeson KE (1993) Laparoscopic gastrostomy and fundoplication. Pediatr Ann 22(11):675–677

    Article  CAS  PubMed  Google Scholar 

  3. Fonkalsrud EW, Ashcraft KW, Coran AG et al (1998) Surgical treatment of gastroesophageal reflux in children: a combined hospital study of 7467 patients. Pediatrics 101(3 Pt 1):419–422

    Article  CAS  PubMed  Google Scholar 

  4. Toupet A (1963) Technic of esophago-gastroplasty with phrenogastropexy used in radical treatment of hiatal hernias as a supplement to Heller’s operation in cardiospasms. Mem Acad Chir (Paris) 89:384–389

    CAS  Google Scholar 

  5. McKernan JB (1994) Laparoscopic repair of gastroesophageal reflux disease. Toupet partial fundoplication versus Nissen fundoplication. Surg Endosc 8(8):851–856

    Article  CAS  PubMed  Google Scholar 

  6. Patti MG, De Pinto M, de Bellis M et al (1997) Comparison of laparoscopic total and partial fundoplication for gastroesophageal reflux. J Gastrointest Surg 1(4):309–314 (discussion 314–315)

    Article  CAS  PubMed  Google Scholar 

  7. Zornig C, Strate U, Fibbe C et al (2002) Nissen vs Toupet laparoscopic fundoplication. Surg Endosc 16(5):758–766

    Article  CAS  PubMed  Google Scholar 

  8. Esposito C, Van Der Zee DC, Settimi A et al (2003) Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired children. Surg Endosc 17(5):708–710

    Article  CAS  PubMed  Google Scholar 

  9. Kamolz T, Granderath FA, Bammer T et al (2002) “Floppy” Nissen vs. Toupet laparoscopic fundoplication: quality of life assessment in a 5-year follow-up (part 2). Endoscopy 34(11):917–922

    Article  CAS  PubMed  Google Scholar 

  10. Hunter JG, Swanstrom L, Waring JP (1996) Dysphagia after laparoscopic antireflux surgery. The impact of operative technique. Ann Surg 224(1):51–57

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Jobe BA, Wallace J, Hansen PD et al (1997) Evaluation of laparoscopic Toupet fundoplication as a primary repair for all patients with medically resistant gastroesophageal reflux. Surg Endosc 11(11):1080–1083

    Article  CAS  PubMed  Google Scholar 

  12. Davis CS, Baldea A, Johns JR et al (2010) The evolution and long-term results of laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease. JSLS 14(3):332–341

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Rothenberg SS (2013) Two decades of experience with laparoscopic Nissen fundoplication in infants and children: a critical evaluation of indications, technique, and results. J Laparoendosc Adv Surg Tech A 23(9):791–794

    Article  PubMed  Google Scholar 

  14. Bloomston M, Nields W, Rosemurgy AS (2003) Symptoms and antireflux medication use following laparoscopic Nissen fundoplication: outcome at 1 and 4 years. JSLS 7(3):211–218

    PubMed Central  PubMed  Google Scholar 

  15. Koch OO, Kaindlstorfer A, Antoniou SA et al (2013) Comparison of results from a randomized trial 1 year after laparoscopic Nissen and Toupet fundoplications. Surg Endosc 27(7):2383–2390

    Article  PubMed  Google Scholar 

  16. Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lonroth H, Olbe L (1996) Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg 83(6):830–835

    Article  CAS  PubMed  Google Scholar 

  17. Granderath FA, Kamolz T, Granderath UM, Pointner R (2007) Gas-related symptoms after laparoscopic 360 degrees Nissen or 270 degrees Toupet fundoplication in gastrooesophageal reflux disease patients with aerophagia as comorbidity. Dig Liver Dis 39(4):312–318

    Article  CAS  PubMed  Google Scholar 

  18. Esposito C, De Luca C, Alicchio F et al (2010) Long-term outcome of laparoscopic Nissen procedure in pediatric patients with gastroesophageal reflux disease measured using the modified QPSG Roma III European Society for Pediatric Gastroenterology Hepatology and Nutrition’s questionnaire. J Laparoendosc Adv Surg Tech A 20(7):661–664

    Article  Google Scholar 

  19. Shariff F, Kiely E, Curry J et al (2010) Outcome after laparoscopic fundoplication in children under 1 year. J Laparoendosc Adv Surg Tech A 20(7):661–664

    Article  PubMed  Google Scholar 

  20. Capito C, Leclair MD, Piloquet H et al (2008) Long-term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children. Surg Endosc 22(4):875–880

    Article  CAS  PubMed  Google Scholar 

  21. Meehan JJ, Georgeson KE (1997) The learning curve associated with laparoscopic antireflux surgery in infants and children. J Pediatr Surg 32(3):426–429

    Article  CAS  PubMed  Google Scholar 

  22. Hagedorn C, Lonroth H, Rydberg L, Ruth M, Lundell L (2002) Long-term efficacy of total (Nissen-Rossetti) and posterior partial (Toupet) fundoplication: results of a randomized clinical trial. J Gastrointest Surg 6(4):540–545

    Article  PubMed  Google Scholar 

  23. Steyaert H, Al Mohaidly M, Lembo MA et al (2003) Long-term outcome of laparoscopic Nissen and Toupet fundoplication in normal and neurologically impaired children. Surg Endosc 17(4):543–546

    Article  CAS  PubMed  Google Scholar 

  24. Zehetner J, Holzinger F, Breuhahn T et al (2006) Five-year results of laparoscopic Toupet fundoplication as the primary surgical repair in GERD patients: is it durable? Surg Endosc 20(2):220–225

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We wish to express our appreciation to Dr. Geoffrey J. Lane who reviewed this manuscript as a native English speaker.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan

    Go Miyano, Masaya Yamoto, Keiichi Morita, Masakatsu Kaneshiro, Hiromu Miyake, Hiroshi Nouso, Mariko Koyama, Hideaki Nakajima, Koji Fukumoto & Naoto Urushihara

Authors
  1. Go Miyano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaya Yamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keiichi Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masakatsu Kaneshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiromu Miyake
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Nouso
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mariko Koyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideaki Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Koji Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Naoto Urushihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Go Miyano.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miyano, G., Yamoto, M., Morita, K. et al. Laparoscopic Toupet fundoplication for gastroesophageal reflux: a series of 131 neurologically impaired pediatric cases at a single children’s hospital. Pediatr Surg Int 31, 925–929 (2015). https://doi.org/10.1007/s00383-015-3770-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-015-3770-4

Keywords

Search

Navigation