90th Annual Meeting Abstracts
Incidence of Small Bowel Obstruction after Laparoscopic Nissen Fundoplication
*Connie J Rossini, MD1, *David B Tashjian, MD2, Kevin P Moriarty, MD2
1Baystate Medical Center / Tufts University School of Medicine, Springfield, MA;2Baystate Children's Hospital / Tufts University School of Medicine, Springfield, MA
Objective: The purpose of this study is to determine the incidence of small bowel obstructions after laparoscopic Nissen fundoplications in children.
Design: Retrospective case series
Setting: Single institution tertiary care hospital
Patients: 195 children who had laparoscopic Nissen fundoplications at a single institution from January 2000 to March 2008. Seven patients were lost to follow up after their index operation. Ages ranged from 1 month to 23 years. Thirty-four of the 195 patients (17%) had other abdominal operations. Mean follow-up time was 43 months with a range of 6 to 102 months.
Interventions: Fifteen repeat laparoscopic Nissen fundoplications were preformed on 14 patients for a total of 210 laparoscopic Nissen fundoplications. The redo rate of laparoscopic Nissen fundoplication in this series is 7%.
Main Outcome Measures: Incidence of small bowel obstruction requiring hospitalization or surgery after laparoscopic Nissen fundoplication in children.
Results: Three patients had admissions for small bowel obstructive symptoms after a laparoscopic Nissen fundoplication. All three patients underwent exploratory laparotomy for presumed high-grade small bowel obstruction. Two patients had a previous exploratory laparotomy in the newborn period, an open Ladd’s procedure for malrotation and small bowel resection for necrotizing enterocolitis, one of which had notable adhesions causing obstruction. The third patient had no other prior surgeries and was found to have obstipation without adhesions. The incidence of small bowel obstruction is 1%.
Conclusions: Small bowel obstruction after laparoscopic Nissen fundoplication in children is a very rare complication compared to historic rates of 10 to 15% after open fundoplication.