Incidence of Small Bowel Obstruction after Laparoscopic Nissen Fundoplication
Connie J. Rossini, MD, David Tashilian, MD, Kevin Moriarty, MD
Baystate Medical Center, Springfield, MA
PURPOSE OF STUDY
The purpose of this study is to determine the incidence of small bowel obstruction after laparoscopic Nissen fundoplications in children. Open fundoplications historically has been associated with high rates of intestinal obstruction up to 10%.
A retrospective review of medical records and radiologic data of all patients who underwent a laparoscopic Nissen fundoplication from January 2000 to March 2008 at a tertiary care hospital was conducted. All hospital admissions were reviewed to determine the incidence of small bowel obstruction requiring hospitalization or surgical intervention in children who have had a laparoscopic Nissen fundoplication.
SUMMARY OF RESULTS
195 children had laparoscopic Nissen fundoplications 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 during the follow up period. Mean follow-up time was 43 months with a range of 6 to 102 months. 79 (40%) patients also had a gastrostomy tube placed at the time of Nissen fundoplication. 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. One patient had a history of an exploratory laparotomy and small bowel resection in the newborn period. The second patient had a history of an open Ladd’s procedure in the newborn period. The third patient was found to have obstipation without any notable adhesions at the time of surgery. All three cases had gastrostomy tubes placed at the time of fundoplication. The incidence of small bowel obstruction in this series is 1% after laparoscopic Nissen fundoplication.
Small bowel obstruction due to adhesions after laparoscopic Nissen fundoplication in children is a very rare complication compared to historic rates of 10% after open fundoplication. We found a 1% risk of small bowel obstruction after laparoscopic Nissen fundoplication only occurring in children who also had a gastric tube placement or other abdominal surgeries.