Document Detail

Fundoplication in paediatric surgery: a survey in 40 German institutions.
MedLine Citation:
PMID:  16418957     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is no generally accepted standard surgical approach to gastrooesophageal reflux disease (GERD) at present. However, laparoscopic fundoplication has been advocated to be the procedure of choice for gastrooesophageal reflux disease in children. We aimed to assess the standards of the diagnostic workup and operative techniques in paediatric surgical institutions in Germany. MATERIAL AND METHODS: A questionnaire including 14 items was sent to all 71 departments of paediatric surgery in Germany. Forty (56 %) took part in the survey. Concepts of routine diagnostic workup, operative techniques, number of procedures, and conversions were assessed. RESULTS: The average annual frequency of fundoplications was less than 20 in 36 units (90 %). Experience with laparoscopic fundoplication was present in 24 institutions (60 %). In 19 out of these (79 %) fewer than 50 laparoscopic fundoplications had been performed altogether up to the time of the survey. Out of 584 fundoplications performed in the year 2002, 184 (32 %) had been done laparoscopically. The ratio of conventional versus laparoscopic fundoplication was 170/130 (57/43 %) in academic, and 226/54 (81/19 %) in non-academic departments. The preferred technique of fundoplication, irrespective of the approach, was the Nissen wrap in 28 (70 %) of the departments. The number of paediatric surgeons performing laparoscopic fundoplication was 1 - 2 in 16 institutions (67 %), 3 or 4 in 6 (25 %), and 5 in 2 (8 %) departments. The conversion rate was reported to be less than 5 % in 15 departments (63 %), and 5 - 10 % in 3 (13 %). CONCLUSION: The laparoscopic approach for surgical repair of GERD in children is not yet generally accepted in Germany. In most departments, training remains problematic due to low numbers of procedures. However, the feasibility of laparoscopic fundoplication in Germany is excellent, with a low rate of conversions.
A I Schmidt; S Glüer; B M Ure
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie     Volume:  15     ISSN:  0939-7248     ISO Abbreviation:  Eur J Pediatr Surg     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2006-01-18     Completed Date:  2006-03-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9105263     Medline TA:  Eur J Pediatr Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  404-8     Citation Subset:  IM    
Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany.
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MeSH Terms
Clinical Competence
Fundoplication / methods,  statistics & numerical data*
Gastroesophageal Reflux / surgery*
Health Care Surveys

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