Multimedia article. Laparoscopic fundoplication in an infant.

BACKGROUND

Laparoscopic fundoplication in infants and children is rapidly becoming the procedure of choice for surgical correction of symptomatic gastroesophageal reflux because of the advantages of reduced discomfort and decreased hospitalization. In addition, there may be a hidden benefit of an earlier return to work by the parents.

METHODS

This video depicts the salient operative features for performing a laparoscopic fundoplication in an infant who presented with an acute life-threatening event, which was felt secondary to gastroesophageal reflux. In this operation, a 5 mm cannula was placed in the umbilicus through which insufflation was achieved and a 5 mm, 45 degrees angled telescope was inserted into the peritoneal cavity. The four instruments were placed directly through the abdominal wall using a stab incision technique rather than using cannulas. Moreover, the operation was performed using AESOP, the voice-activated telescopic holder, which provides a steady and consistent view.

RESULTS

The operative technique was straightforward in that the short gastric vessels were divided, the crura were closed, and the esophagus was secured to the crura to keep the esophagus in an intraabdominal position and to prevent transmigration of the fundoplication wrap in the postoperative period. The length of the fundoplication should be around 2.0 cm and was measured to ensure that the fundoplication approximates this length.

CONCLUSION

This patient made an eventful recovery and was discharged the following day. No complications have developed. [The full text of this article is a video computer file.]