Evolution of the modified Rossetti fundoplication in children: surgical technique and results

• Published in: Annals of surgery Vol. 229; no. 6; pp. 774 - 9; discussion 779-80
• Main Authors: Levy, M S, Sorrels, C W, Wagner, C W, Jackson, R J, Barnes, R W, Smith, S D
• Format: Journal Article
• Language: English
• Published: United States 01-06-1999
• Subjects: Child, Preschool; Fundoplication - methods; Humans; Retrospective Studies; Scientific Papers of the Southern Surgical Association; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199906000-00003

To compare the modified Rossetti fundoplication with the classic Nissen.
The traditional surgical treatment of gastroesophageal reflux in children has been the classic Nissen fundoplication, defined by liver mobilization, crural repair, takedown of short gastric vessels, and floppy wrap. The authors have progressed in our technique of fundoplication and now perform a modified Rossetti fundoplication, defined by liver retraction without mobilization, no crural repair, short gastric vessels left intact, and 2-cm floppy wrap.
A retrospective chart review was performed on 407 pediatric patients who had open fundoplications (Jan. 13, 1993, to Feb. 25, 1998). Two groups were analyzed: the Nissen group (171 patients) and the Rossetti group (236 patients). Groups were compared for incidence of recurrent reflux, dysphagia, hiatal hernia, need for esophageal dilation, revision of fundoplication, time to discharge, and operative time.
Incidence of dysphagia (3.7% vs. 3.3%), postoperative hiatal hernia (1.9% vs. 1.4%), need for esophageal dilation (1.2% vs. 0.5%), and need for fundoplication revision (2.5% vs. 2.3%) were similar between the groups. The mean operative time was significantly decreased in the Rossetti group (65 +/- 25 minutes) versus the Nissen group (73 +/- 33 minutes). Recurrent reflux occurred significantly more often in the Nissen group (11.2%) than in the Rossetti group (5.1 %).
The modified Rossetti fundoplication has a low complication rate and is the authors' preferred method for the surgical treatment of gastroesophageal reflux in children.