Philippe Montupet

Laparoscopic Toupet Fundoplication in Children

Background: The laparoscopic approach for antireflux surgery is becoming the gold standard for children with gastroesophageal reflux disease (GERD) when surgical treatment is indicated. Preferences for a partial or a full fundoplication still relate to the surgeons choice and experience. Patients and Methods: Between 1993 and 1999, we operated on 284 children with GERD. A laparoscopic Toupet fundoplication with a four-trocar technique was performed in all the cases. Results: All patients demonstrate clinical improvement and disappearance of the GERD. Transient postoperative nausea, pain, and diarrhea were reported occasionally. Dysphagia was unusual. Postoperative complications included three eviscerations through port wounds. Valve failure occurred in six patients. Conclusion: Laparoscopic Toupet fundoplication is an excellent surgical alternative in children with GERD.

Complications of Laparoscopic Minimally Invasive Surgery

Introduction: Reports of complications during pediatric laparoscopic procedures are seldom found in the international literature. The aim of this paper is to provide an overview of the complications of laparoscopic minimally invasive surgery (MIS) in children and their management. Methods: The authors analyzed the results of their 10 years of experience in pediatric laparoscopic surgery, in addition to the data on this topic found in the international literature. Results: The incidence of complications occurring during laparoscopic MIS appears to be about 5%. In about 70% of cases, the complications can be managed laparoscopically, whereas in 30% of cases, a conversion to open surgery is required. Complications related to use of the Veress needle or placement of the first trocar are rare thanks to the routine use of open laparoscopy; other types of complications appear to be related to the experience of the surgeon, especially in suturing and intracorporeal knot tying. In an increasing number of cases, so...

Can Laparoscopy Be Considered the “Gold Standard“ in the Management of Children with GERD?

Laparoscopic antireflux surgery (LARS) in adults has semmingly replaced the open approached worldwide (6,11, 12,63]. Findings show it to be an established treatment option for chronic gastroesophageal reflux disease, with an excellent clinical outcome and success rates ranging between 90% and 100% [6].

Hiatal Hernia and Gastroesophageal Reflux

A hiatal hernia is a partial gastric pull-up across the hiatal orifice. Gastroesophageal reflux (GER) is frequently associated. On the contrary, a GER disease can exist without anatomical hiatal hernia. In many instances, a small hiatal hernia and slight or transient GER are asymptomatic or well tolerated.

Malpractice in paediatric minimally invasive surgery – a current concept: Results of an international survey

This study aimed to assess malpractice in paediatric minimally invasive surgery (MIS), and attitudes, prevention strategies and mechanisms to support surgeons while they are under investigation. An observational, multicentric, questionnaire-based study was conducted. The survey questionnaire was sent via mail, and it comprised four sections. Twenty-four paediatric surgeons (average age 54.6 years), from 13 different countries, participated in this study. The majority had >15 years of experience in MIS. Three (12.5%) surgeons reported a total of five malpractice claims regarding their MIS activity. The reasons for the claims were a postoperative complication in 3/5 (60%) cases, a delayed/failed diagnosis in 1/5 (20%) cases and the death of the patient in 1/5 (20%) cases. The claims concluded with the absolution of the surgeon in all cases, and monetary compensation to the claimant in two (40%) cases. Eleven (45.8%) surgeons were invited as expert counsels in medico-legal actions. Medico-legal aspects have a minimal impact on the MIS activity of paediatric surgeons. In this series, claims concluded with the absolution of the surgeon in all cases, but they had a negative effect on the surgeon’s reputation and finances. A key element in supporting surgeons while they are under investigation is always to choose a surgeon who is an expert in paediatric MIS as legal counsel. A constant update on innovations in paediatric MIS and appropriate professional liability insurance may also play a key role in reducing medico-legal consequences.

Redo Surgery in Cases of Recurrent GER

Gastroesophageal fundoplication can actually be considered one of the most common operations performed by pediatric surgeons on infants and children [5,15].