Laparoscopic Nissen fundoplication is more cost-effective than open Nissen fundoplication in children.

Abstract

Background: Nissen fundoplication is one of the most common surgical procedures for gastroesophageal reflux. Current and previous research comparing laparoscopic Nissen fundoplication (LNF) versus open Nissen fundoplication (ONF) in children suggest ambiguous conclusions. The purpose of this retrospective study was to compare the outcome for children operated with LNF or ONF at our institution and to evaluate the economic aspects.

Methods: 32 consecutive patients (LNF: n = 18, ONF: n = 14) operated with Nissen fundoplication between the years 2011-2017 were included in the study. Data was collected by examination of the patient journals and preoperative, operative, postoperative, and post-discharge parameters were analyzed.

Results: Compared to ONF, the LNF group had shorter operating time (165.2 vs 216.6 min, p < 0.05), shorter overall operating room duration (315.0 vs 334.9 min, p < 0.05) and shorter postoperative hospital stay (3.8 vs 8.1 days, p < 0.05). The LNF group also required less morphine (1.2 vs 1.7 mg/kg, p < 0.05) and the total cost per case was 39% lower (261.1 vs 427.4 kSEK, p < 0.05). No difference was seen in postoperative complications and results.

Conclusion: Laparoscopic Nissen fundoplication is more cost-effective compared to open surgery and reduces postoperative hospital stay and morphine requirements.