Lucy Fulford-Smith, Tom Cundy, Naved Alizai, Azad Najmaldin
Leeds Children's Hospital, Leeds General Infirmary, Leeds, United Kingdom


Aim: The place of a robotic assisted approach in paediatric fundoplication remains controversial.  We report the application of the technique in chronically ill infants and children.

Methods: All patients who underwent robotic assisted Nissen’s fundoplication with or without a hiatal repair and gastrostomy between May 2006 and February 2017 were included. An open technique peri-umbilical optic port (8-12 mm), two robotic working ports (5-8mm), one accessary laparoscopic port (3-5mm), and a Nathason’s retractor were used in all. Data was recorded prospectively and postoperative follow up was regular throughout the study period.

Results: There were 72 procedures in 71 children. Of these, 29 were infants and toddlers (median age 1.2 years, range 4 weeks to 2 years, with the smallest being 4.2kg, 28/29 required a gastrostomy) and 43 older children (median age 10.6 years, range 3-16, 15/43 required a gastrostomy). Significant chronic co-morbid illnesses were very high (infants/toddlers 100%, older children 84%). 29.2% had pre-existing abdominal scarring. No procedure required conversion. Per and post - operative complications included : minor sero-muscular tear (x1), gastric wall perforation by the needle during a gastrostomy insertion (x1), inability to retrieve a pre-existing PEG (x1), minor skin pressure sore (x1), melena (x1, endoscopy normal), leaking gastrostomy (x2), early and late dysphagia (x4, unremarkable endoscopy and contrast study in all) and a redo procedure (x1). The mean operating time was 96 minutes (range 47 - 155). No significant difference was found between the young and older children for operating time, complication rates and redo procedure rates. Hospital stay depended on the patients pre-existing illnesses and the time required to establish the gastrostomy feed.

Conclusions: Given the high incidence of co-morbid illnesses in this series, safety and feasibility of robotic assisted fundoplication does not seem limited by age.