Abstract
A neurologically impaired child with both a percutaneous endoscopic gastrostomy (PEG) and a ventriculoperitoneal shunt (VPS) underwent an antireflux procedure because of drug-resistant emesis and recurrent aspiration pneumonitis. Previous surgeries prevented the use of our standard four-port technique, and we achieved a complete fundoplication with three ports, at times taking advantage of an operating laparoscope. The lesser omentum was opened without injury to the left hepatic branch of the vagus nerve; the distal esophagus was dissected free of the diaphragmatic crura, and a retroesophageal window was created for a 360-degree loose wrap fixed to the esophagus. Neither the PEG nor the VPS was disturbed. The operative time was about 120 minutes. Bowel function returned promptly, and the child remains asymptomatic. In patients who have previously undergone surgery, laparoscopic exploration and planning obviate the need to convert a case to laparotomy.
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