Laparoscopic Nissen fundoplication without division of short gastric vessels in children Donald C. Liu * , Tony Lin, Mindy B. Statter, Loretto Glynn, Marcovalerio Melis, Yun Chen, Jianghua Zhan, Beth T. Zimmermann, William A. Loe, Charles B. Hill University of Chicago Comer Children’s Hospital, Chicago, IL 60637, USA Abstract Purpose: It has been suggested that routine division of short gastric vessels (SGVs) results in a more bfloppy Q Nissen fundoplication leading to improved outcomes, that is, less dysphagia and lower incidences of recurrent gastroesophageal reflux disease (GERD). The aim of this retrospective study was to assess whether laparoscopic Nissen fundoplication without division of SGVs (Rossetti modification) (laparoscopic Nissen-Rossetti fundoplication [LNRF]) is associated with acceptable clinical outcome in children. Method: The charts of 368 children who underwent LNRF between January 1996 and September 2004 by 1 primary surgeon were retrospectively reviewed. Children were divided into 2 groups: LNRF + gastrostomy (A) and LNRF alone (B). Mean follow-up period of all groups was 4.2 years. Results: Laparoscopic Nissen-Rossetti fundoplication was completed in 99% (365/368). Mean operating time for group A was 74 minutes and 61 minutes for group B. None in group A required postoperative esophageal dilatation, and 9 in group B (22.5%) required 12 dilatations; 3.6% developed recurrent GERD, 3.7% in group A and 2.5% in group B. Conclusion: Laparoscopic Nissen-Rossetti fundoplication can be performed with acceptable long-term outcome in children, especially in the majority also requiring chronic gastrostomy access. Short-term, reversible dysphagia may be seen in a small percentage of children having fundoplication alone. D 2006 Elsevier Inc. All rights reserved. The traditional surgery for severe gastroesophageal reflux disease (GERD) performed by most pediatric surgeons has been the Nissen fundoplication [1-5]. In 1983, Randolph [6] reported his large series with the Nissen fundoplication via laparotomy in children, emphasizing the steps of detaching the left lobe of the liver from the diaphragm, crural repair, and division of the short gastric vessels (SGVs) to create an adequate fundic wrap to prevent reflux. Even with the emergence of laparoscopic fundoplication as an important modification, most large series of children follow technical guidelines essential to the classic Nissen fundoplication, notably the routine division of SGVs to facilitate the crea- tion of a bfloppyQ wrap [7-9]. Division of SGVs has been proposed to be an essential element in the construction of a floppy complete fundic wrap, which according to many authors in both adult and pediatric literature is a prerequisite in preventing postoperative dysphagia, gas bloat, and importantly, recurrent reflux via wrap breakdown from undue tension [10,11]. Although some retrospective studies in 0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.10.016 Presented at the 36th Annual Meeting of the American Pediatric Surgical Association, Phoenix, AZ, May 29-June 1, 2005. * Corresponding author. Fax: +1 773 702 1192. E-mail address: dliu@surgery.bsd.uchicago.edu (D.C. Liu). Index words: Nissen fundoplication; Rossetti; Short gastric vessels; Dysphagia; Recurrence Journal of Pediatric Surgery (2006) 41, 120 – 125 www.elsevier.com/locate/jpedsurg