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van der Perk MEM, van der Kooi ALLF, Broer SL, Mensink MO, Bos AME, van de Wetering MD, van der Steeg AFW, van den Heuvel-Eibrink MM. A systematic review on safety and surgical and anesthetic risks of elective abdominal laparoscopic surgery in infants to guide laparoscopic ovarian tissue harvest for fertility preservation for infants facing gonadotoxic treatment. Front Oncol 2024; 14:1315747. [PMID: 38863640 PMCID: PMC11165185 DOI: 10.3389/fonc.2024.1315747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/17/2024] [Indexed: 06/13/2024] Open
Abstract
Background Infertility is an important late effect of childhood cancer treatment. Ovarian tissue cryopreservation (OTC) is established as a safe procedure to preserve gonadal tissue in (pre)pubertal girls with cancer at high risk for infertility. However, it is unclear whether elective laparoscopic OTC can also be performed safely in infants <1 year with cancer. This systematic review aims to evaluate the reported risks in infants undergoing elective laparoscopy regarding mortality, and/or critical events (including resuscitation, circulatory, respiratory, neurotoxic, other) during and shortly after surgery. Methods This systematic review followed the Preferred reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guideline. A systematic literature search in the databases Pubmed and EMbase was performed and updated on February 15th, 2023. Search terms included 'infants', 'intubation', 'laparoscopy', 'mortality', 'critical events', 'comorbidities' and their synonyms. Papers published in English since 2000 and describing at least 50 patients under the age of 1 year undergoing laparoscopic surgery were included. Articles were excluded when the majority of patients had congenital abnormalities. Quality of the studies was assessed using the QUIPS risk of bias tool. Results The Pubmed and Embase databases yielded a total of 12,401 unique articles, which after screening on title and abstract resulted in 471 articles to be selected for full text screening. Ten articles met the inclusion criteria for this systematic review, which included 1778 infants <1 years undergoing elective laparoscopic surgery. Mortality occurred once (death not surgery-related), resuscitation in none and critical events in 53/1778 of the procedures. Conclusion The results from this review illustrate that morbidity and mortality in infants without extensive comorbidities during and just after elective laparoscopic procedures seem limited, indicating that the advantages of performing elective laparoscopic OTC for infants with cancer at high risk of gonadal damage may outweigh the anesthetic and surgical risks of laparoscopic surgery in this age group.
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Affiliation(s)
| | - Anne-Lotte L. F. van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Obstetrics and Gynecology, Erasmus MC–University Medical Center, Rotterdam, Netherlands
| | - Simone L. Broer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Medical Center (UMC) Utrecht, Utrecht, Netherlands
| | | | - Annelies M. E. Bos
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Medical Center (UMC) Utrecht, Utrecht, Netherlands
| | | | | | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Child Health, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Elmehdi S, Ley D, Aumar M, Coopman S, Guimber D, Nicolas A, Antoine M, Turck D, Kyheng M, Gottrand F. Endoscopic Gastrojejunostomy in Infants and Children. J Pediatr 2022; 244:115-119.e1. [PMID: 35108546 DOI: 10.1016/j.jpeds.2022.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/02/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the feasibility of endoscopic gastrojejunal tube (GJT) placement in infants and children. STUDY DESIGN All children undergoing endoscopic GJT placement between January 2010 and December 2019 were included in this single-center retrospective study. Difficulties with and failure of GJT placement, complication rates, and device longevity, efficacy, and duration were assessed. RESULTS A total of 107 children, median age 10 months (IQR, 5.0-23.0 months) and median weight 6.6 kg (IQR, 5.3-9.5 kg), underwent endoscopic GJT placement using the gastric stoma to introduce the endoscope (one step: n = 36 of 107; 33.6%). Endoscopic placement was successful in 99%. Eight periprocedure complications occurred, including 1 pneumoperitoneum requiring exsufflation, 2 acute pulmonary hypertension episodes leading to death in 1 case, and 5 episodes of bronchospasm. Minor complications were frequent and mostly mechanical (79%), whereas major complications were rare (5.6%): intussusception (n = 4), intestinal perforation (n = 1), and pneumoperitoneum (n = 1). Ten patients died. Of the 97 patients who lived, 85 (87%) were weaned from jejunal feeding at a median of 179 days (IQR, 69-295 days) after initiation. Among them, 30 (35.2%) required fundoplication. Weight for age z-score was significantly higher at weaning. CONCLUSIONS GJT placement is feasible in children, even low-weight infants. Complications are frequent but are mostly minor.
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Affiliation(s)
- Sophia Elmehdi
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France.
| | - Delphine Ley
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France; Inserm, U1286, Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Madeleine Aumar
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France; Inserm, U1286, Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Stéphanie Coopman
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France
| | - Dominique Guimber
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France
| | - Audrey Nicolas
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France
| | - Matthieu Antoine
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France
| | - Dominique Turck
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France; Inserm, U1286, Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Maeva Kyheng
- Division of Methodology, Biostatistics, and Data Management, University of Lille, CHU Lille, Lille, France
| | - Frédéric Gottrand
- Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France; Inserm, U1286, Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
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3
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Gilna GP, Saberi RA, Baez AC, Ribieras AJ, Cioci AC, Urrechaga EM, Parreco JP, Perez EA, Sola JE, Thorson CM. Nationwide Outcomes and Readmission After Pediatric Laparoscopic and Open Fundoplication. J Laparoendosc Adv Surg Tech A 2021; 31:1389-1396. [PMID: 34851741 DOI: 10.1089/lap.2021.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Fundoplications are a common operation in the pediatric population. This study aims to explore outcomes comparing laparoscopic versus open operative techniques. Methods: From 2010 to 2014 the Nationwide Readmissions Database was used to identify patients aged 0-18 years who underwent a fundoplication. Propensity score matched analysis was performed based on 87 covariates. Demographics, hospital factors, readmissions, and complications were compared by surgical technique (laparoscopic versus open). Results: There were 4411 patients (47% female) who underwent fundoplication via laparoscopic (69%) versus open (31%) technique. Gastrostomy tubes were placed in 75% of patients also undergoing fundoplication. Newborn made up 64% of the cohort, with 47% of newborns having cardiac anomalies and 96% being premature. Open fundoplications were more likely to be performed in newborns (72% versus 61%) and those in the lowest income quartile compared to laparoscopic (41% versus 31% P < .001), both P < .001. The readmission rate was 20% within 30 days and 38% within the year, with 15% admitted to a different hospital. Only 14% of readmissions were elective. Open fundoplication was associated with more unplanned readmissions (94% versus 84%), conversion to gastrojejunostomy tube (11% versus 5%) along with major (5% versus 3%) and minor (8% versus 2%) complications compared to the laparoscopic approach, all P < 0.001. Conclusion: The majority of fundoplications are being performed in newborns and are being done laparoscopically, which are associated with lower complication and postoperative readmission rates compared to open fundoplications.
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Affiliation(s)
- Gareth P Gilna
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rebecca A Saberi
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adriana C Baez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Antoine J Ribieras
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alessia C Cioci
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eva M Urrechaga
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua P Parreco
- Division of Trauma and Surgical Critical Care, Memorial Regional Hospital, Hollywood, Florida, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chad M Thorson
- Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
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Experience with a Hybrid Procedure Involving Laparoscopic Fundoplication with Percutaneous Endoscopic Gastrostomy in Chronically Ill Children. J Clin Med 2021; 10:jcm10194291. [PMID: 34640329 PMCID: PMC8509801 DOI: 10.3390/jcm10194291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 01/30/2023] Open
Abstract
Gastrostomy with concurrent laparoscopic Nissen fundoplication (LNF) is often performed as a laparoscopic gastrostomy (LG) by surgeons. Since 2014, we started performing percutaneous endoscopic gastrostomy (PEG) as gastrostomy with LNF. This study aims to compare the outcomes of LG and PEG with LNF. Patients were recruited into two groups: LNF with LG (historical control) or PEG. Demographic data, operation time, time to start feeding, time to full feeding, length of hospital stay (LOS), and complications were compared between the groups. Fourteen patients underwent LNF with LG and 49 underwent LNF with PEG. The median age and body weight of patients were 4.25 years and 14.15 kg in the LG group and 2.58 years and 10.60 kg in the PEG group, respectively. Operation times were significantly shorter in the PEG group (1.81 vs. 2.61 h). The times to start feeding and full feeding as well as LOS were shorter in the PEG group. Nevertheless, complications were similar in both groups. In conclusion, PEG with LNF was associated with significantly shorter operation times, times to start feeding and reach full feeding, and LOS. PEG is a suitable method for LNF in chronically ill children.
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5
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Svetanoff WJ, Dekonenko C, Briggs KB, Fraser J, Oyetunji TA, St. Peter SD. Are Posterior Crural Stitches Necessary in Pediatric Laparoscopic Fundoplication? J Laparoendosc Adv Surg Tech A 2020; 30:1272-1276. [DOI: 10.1089/lap.2020.0646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Charlene Dekonenko
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
- Department of General Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kayla B. Briggs
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - James Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Tolulope A. Oyetunji
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
- Univeristy of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Shawn D. St. Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
- Univeristy of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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6
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Shah AA, Matisoff A, Deutsch N, Sandler A, Kane T, Petrosyan M. A Team-Based Approach for Children With Congenital Cardiac Disease Undergoing Antireflux Procedure With Gastrostomy. Am Surg 2020; 87:427-431. [PMID: 33026240 DOI: 10.1177/0003134820951472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Laparoscopic Nissen fundoplication with gastrostomy tube (LPNF-GT) placement is often indicated in children with congenital cardiac diseases (CCDs) for nutritional optimization. This study aims to evaluate institutional outcomes of LPNF-GT, with a team-based approach in operative management. METHODS Five years of an institutional database at a tertiary care children's hospital was queried for LPNF-GT in children with CCDs. Descriptive analyses were performed. A national comparison was performed utilizing the 2012-2013 Pediatrics NSQIP database, using propensity score matching. Outcome measures of interest were operative-time, unplanned readmission, and 30-day mortality. RESULTS A team-based approach was utilized in 51 cases. Median operative time was 68.5 (IQR: 48-89) minutes. All patients tolerated tube feeds postoperatively. All patients survived 30 days post surgery. When compared to 136 similarly matched children nationally, the risk-adjusted operative time with a team-based approach was 47.38 (12.43-82.33) minutes shorter (P < .05). There were no statistically significant differences in the likelihood of being in the hospital past 30 days, unplanned readmissions, and mortality (P > .05). CONCLUSION LPNF-GT can be safely performed in children with CCDs. A team-based approach demonstrates improved operative time and achieved similar outcomes when compared nationally.
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Affiliation(s)
- Adil A Shah
- 233494 Department of General and Thoracic Surgery, Children's National Health System, Washington, DC, USA.,Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA
| | - Andrew Matisoff
- Department of Anesthesiology, Children's National Medical Center, Washington, DC, USA
| | - Nina Deutsch
- Department of Anesthesiology, Children's National Medical Center, Washington, DC, USA
| | - Anthony Sandler
- 233494 Department of General and Thoracic Surgery, Children's National Health System, Washington, DC, USA
| | - Timothy Kane
- 233494 Department of General and Thoracic Surgery, Children's National Health System, Washington, DC, USA
| | - Mikael Petrosyan
- 233494 Department of General and Thoracic Surgery, Children's National Health System, Washington, DC, USA
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