Laparoscopic Thal versus laparoscopic Nissen fundoplication in children: Comparative study regarding outcome and patient satisfaction

Abstract

Introduction Gastroesophageal reflux disease is a common condition in pediatric age group. Many surgeons believe that complete fundoplication provides better reflux control, yet it results in more dysphagia and gas-bloat symptoms. On the other hand, a partial wrap is reported to have fewer adverse effects but a higher failure rate in controlling reflux. Until now, there is no agreement and little evidence as to whether complete or partial  fundoplication is the optimal procedure in this age group.

Patients and methods This is a prospective singleblinded randomized comparative study that included 30 patients who were admitted in the time period from May 2013 to May 2015 and were treated laparoscopically byeither Nissen or Thal fundoplication.

Results Operative time (minutes) was significantly longer in the Thal group (186 ± 52) when compared with the Nissen group (150 ±48) (P =0.031). Intraoperative complications showed no significant difference when comparing the two groups. Although the incidence of postoperative dysphagia was statistically insignificant, the duration of dysphagia did  show significantly shorter duration in the Thal group (median: 6 days), when compared with the Nissen group (median: 17 days). There was no recurrence in the Thal group, whereas there was one recurrence in the Nissen group.

Conclusion This study suggests that Thal fundoplication offers an effective alternative to Nissen fundoplication with apparently shorter duration of dysphagia and thus earlier return to the normal eating pattern. Level of evidence: