1
|
Kiblawi R, Zoeller C, Zanini A, Kuebler JF, Dingemann C, Ure B, Schukfeh N. Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies. Eur J Pediatr Surg 2022; 32:9-25. [PMID: 34933374 DOI: 10.1055/s-0041-1739418] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery. MATERIALS AND METHODS Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien-Dindo classification. RESULTS A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien-Dindo grade I to III complications (mild-moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades. CONCLUSION Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.
Collapse
Affiliation(s)
- Rim Kiblawi
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Zoeller
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.,Department of Pediatric Surgery, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Andrea Zanini
- Department of Pediatric Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Carmen Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Richards CA. Postfundoplication retching: Strategies for management. J Pediatr Surg 2020; 55:1779-1795. [PMID: 32409173 DOI: 10.1016/j.jpedsurg.2020.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Retching is a common symptom in children following antireflux surgery, particularly in those with neurodisability. There is now a strong body of evidence that implicates retching as a major cause of wrap breakdown. Retching is not a symptom of gastroesophageal reflux disease; it is a component of the emetic reflex. In addition to causing wrap breakdown, it is indicative of the presence of nausea. It is a highly aversive experience and warrants treatment in its own right. METHODS A framework was constructed for the management of postoperative retching, with strategies targeting different components of the emetic reflex. The impact of differing antireflux procedures upon retching was also considered. CONCLUSIONS Once treatable underlying causes have been excluded, the approach includes modifications to feeds and feeding regimens, antiemetics and motility agents. Neuromodulation and other, novel, therapies may prove beneficial in future. Children at risk of postoperative retching may be identified before any antireflux surgery is performed. Fundoplication is inappropriate in these children because it does not treat their symptoms, which are not because of gastroesophageal reflux, and may make them worse. They are also at risk of wrap disruption. Alternative strategies for symptom management should be employed, and fundoplication should be avoided. LEVEL OF EVIDENCE II-V.
Collapse
Affiliation(s)
- Catherine A Richards
- Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| |
Collapse
|
4
|
Saitua F, Weibel A, Herrera P. Gastrostomy: A percutaneous laparoscopic technique. J Pediatr Surg 2019; 54:2182-2186. [PMID: 31280878 DOI: 10.1016/j.jpedsurg.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/27/2019] [Accepted: 06/10/2019] [Indexed: 11/25/2022]
Abstract
Several techniques are available for a gastrostomy concomitant with a major abdominal surgery, i.e., there is no 'standard' technique. Here, we present our results of a novel concomitant gastrostomy developed for the Nissen fundoplication. It combines the laparoscopic instrumentation with the kit for percutaneous endoscopic gastrostomy. Once the fundoplication is completed, the gastrostomy is performed in three stages. First, with the orogastric tube and snare, the loop of wire is left in the peritoneal cavity; next, a guide-wire introduced into the peritoneal cavity from the abdominal wall, is taken with the loop, and retrieved at the mouth; finally, the gastrostomy tube is pulled with the guide-wire from mouth to abdominal wall. Only laparoscopic instrumentation is used to choose the site in the stomach, and to perform the puncture; hence, the gastroscope is unnecessary. By choosing the proper sites, stomata are aligned and free of lateral strains making the gentle pressure of the dome enough to appose gastric and abdominal walls; hence, stitches become unnecessary to affix the walls. This percutaneous laparoscopic gastrostomy is simple, brief (ca 21 min), well tolerated, without complications during the intervention or the postoperatory period, reproducible, and of low cost, and exceptional skills are not required. Finally, laparoscopic protocols for a primary gastrostomy may dispel some complications by choosing a 'pull' to install the gastrostomy tube as reported here, instead of the usual 'push'.
Collapse
Affiliation(s)
- Francisco Saitua
- Hospital Luis Calvo Mackenna, Santiago, Chile; Universidad de Chile, Santiago, Chile; Clínica Alemana de Santiago, Chile.
| | - Alvaro Weibel
- Hospital Luis Calvo Mackenna, Santiago, Chile; Clínica Alemana de Santiago, Chile
| | | |
Collapse
|
5
|
Laparoscopic Gastrostomy in Children: 10 Years of Experience. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:169-172. [PMID: 32595393 PMCID: PMC7315087 DOI: 10.14744/semb.2017.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/26/2017] [Indexed: 11/20/2022]
Abstract
Objectives Laparoscopic gastrostomy is a widely used procedure in children with failure to thrive, feeding disorders, or neurologic impairment. Various methods of laparoscopic gastrostomy and fixing stomach to abdominal wall have been described. Trocar site primary gastrostomy under laparoscopic control is a simple and easy technique that does not require special instruments and a kit. The aim of this study was to present 10 years of experience in laparoscopic gastrostomy. Methods The charts of 128 children who underwent laparoscopic gastrostomy between 2006 and 2016 were retrospectively reviewed. The data, including demographics, operative procedures, and complications, were recorded. All children underwent preoperative contrast imaging and 24-hour Ph monitorization. In all patients, the trocar site primary gastrostomy was done. A gastrostomy tube or a button was inserted into the stomach in the center of a purse-string suture loop, and the stomach was fixed to the anterior rectus sheath extracorporeally. Results There were 49 girls (38.3%) and 79 boys (61.7%). The mean age was 50 months at surgery (1 day-18 years), and the average body weight was 13 kg (2300 gr-65 kg). Both laparoscopic Nissen fundoplication and gastrostomy were done in 116 (90.6%) patients, and 12 (9.4%) patients had only laparoscopic gastrostomy. Infection at the site of gastrostomy, which was treated by antibiotics, was the most common complication, observed in 14 (11%) patients. Peritoneal leakage within 30 days was seen in 9 (7%) patients. Severe dislodgement of gastrostomy resulting in operative intervention occurred in 5 (3.9%) patients. Granuloma developed in 4 (3.1%) patients and was treated with silver nitrate. Conclusion The trocar site primary laparoscopic gastrostomy is a safe and easy technique with complication rates comparable to other gastrostomy methods.
Collapse
|
6
|
Open versus laparoscopic approach to gastric fundoplication in children with cardiac risk factors. J Surg Res 2017; 220:52-58. [PMID: 29180211 DOI: 10.1016/j.jss.2017.05.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/24/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gastric fundoplication is the most common noncardiac operation in children with congenital cardiac disease. While prior studies validated safety of laparoscopy in this population, we hypothesize that children with cardiac risk factors (CRFs) are likelier to undergo open fundoplication (OF) but experience greater morbidity than after laparoscopic fundoplication (LF). MATERIALS AND METHODS Utilizing 2013 National Surgical Quality Improvement Program-Pediatrics Public-Use-File, pediatric patients undergoing LF and OF were stratified to none, minor, major, or severe CRFs. Multivariate logistic regression determined preoperative variables and postoperative outcomes associated with LF or OF. RESULTS A total of 1501 fundoplication patients were identified with 92% undergoing LF. OF patients were likelier to have minor (odds ratio [OR]: 2.36, P < 0.001), major (OR: 2.41, P = 0.003), and severe CRFs (OR: 4.36, P < 0.001). Children ≤ 1 y (OR: 3.38, P = 0.048) and those with tracheostomy were likelier to have OF (OR: 2.3, P = 0.006). Overall, the OF group had higher postoperative morbidity (OR: 2.41, P < 0.001). Specifically, children with minor or major CRFs experienced more complications following OF compared to LF. CONCLUSIONS OF is more common in patients ≤1 y old; patients with minor, major, or severe CRFs; and those with tracheostomy. LF should be considered in children with minor and major CRFs, as OF in those patients results in greater pulmonary, infectious, and hematological sequelae.
Collapse
|
7
|
Yap BKY, Nah SA, Chen Y, Low Y. Fundoplication with gastrostomy vs gastrostomy alone: a systematic review and meta-analysis of outcomes and complications. Pediatr Surg Int 2017; 33:217-228. [PMID: 27889821 DOI: 10.1007/s00383-016-4028-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE We compare the outcomes of fundoplication with gastrostomy vs gastrostomy alone and review the need for subsequent fundoplication after the initial gastrostomy alone. METHODS We searched studies published from 1969 to 2016 for comparative outcomes of concomitant fundoplication with gastrostomy (FGT) vs gastrostomy insertion alone (GT) in children. Gastrostomy methods included open, laparoscopic, and endoscopic procedures. Primary aims were minor and major complications. Secondary aims included post-operative reflux-related complications, fundoplication specific complications, and need for subsequent fundoplication after GT. RESULTS We reviewed 447 studies; 6 observational studies were included for meta-analysis, encompassing 2730 children undergoing GT (n = 1745) or FGT (n = 985). FGT was associated with more minor complications [19.9 vs 11.4%, OR 2.02, 95% confidence interval (CI) 1.43-2.87, p ≤ 0.0001, I 2 = 0%], minor complications requiring revision (6.8 vs 3.0%, OR 2.27, 95% CI 1.28-4.05, p = 0.005, I 2 = 0%), and more overall complications (21.3 vs 12.0%, OR 1.99, 95% CI 1.43-2.78, p < 0.0001, I 2 = 0%). Incidence of major complications (1.8 vs 2.0%, OR 1.39, 95% CI 0.62-3.11, p = 0.42, I 2 = 5%) and reflux-related complications (8.8 vs 10.3%, OR 0.75, 95% CI 0.35-1.68, p = 0.46, I 2 = 0%) in both groups was similar. Incidence of subsequent fundoplication in GT patients was 8.6% (mean). CONCLUSIONS Gastrostomy alone is associated with fewer minor and overall complications. Concomitant fundoplication does not significantly reduce reflux-related complications. As few patients require fundoplication after gastrostomy, current evidence does not support concomitant fundoplication.
Collapse
Affiliation(s)
- Brendan K Y Yap
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Shireen Anne Nah
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yong Chen
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yee Low
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| |
Collapse
|
8
|
Kim J, Sun Z, Englum BR, Allori AC, Adibe OO, Rice HE, Tracy ET. Laparoscopy Is Safe in Infants and Neonates with Congenital Heart Disease: A National Study of 3684 Patients. J Laparoendosc Adv Surg Tech A 2016; 26:836-839. [PMID: 27455201 DOI: 10.1089/lap.2016.0232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Concerns have been raised about the use of laparoscopic surgery (LS) in infants with congenital heart disease (CHD) due to their unique physiology. Prior studies on the safety and effectiveness of laparoscopy in children with CHD are limited in scope and cohort size. MATERIALS AND METHODS We identified children <1 year of age with CHD who underwent abdominal surgery in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Project Pediatric database. Patients were stratified by surgical approach: open surgery (OS) versus LS. We then compared postoperative complications, postoperative length of stay, and 30-day mortality by using multivariable regression methods. RESULTS In total, 3684 patients met study criteria: 2502 underwent OS while 1182 underwent LS. Infants who underwent LS were older (98 days versus 36 days), larger by weight (4.2 kg versus 3.2 kg), and more likely to require nutritional support preoperatively (74.7% versus 60.5%) (all P < .001). After multivariable adjustment, LS was associated with lower overall complication rate (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.34-0.52, P < .001) and shorter postoperative length of stay (effect size -1.8 days, 95% CI -1.8-1.2, P < .001). LS and OS demonstrated similar 30-day mortality (OR 0.71, 95% CI 0.38-1.32, P = .28). CONCLUSIONS Laparoscopy can be performed safely in infants with CHD who need abdominal surgery. Although further studies may be useful in determining which infants with congenital cardiac disease benefit the most from use of laparoscopy, minimally invasive techniques can be applied to routine and complex abdominal procedures.
Collapse
Affiliation(s)
- Jina Kim
- 1 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Zhifei Sun
- 1 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Brian R Englum
- 1 Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Alexander C Allori
- 2 Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center , Durham, North Carolina
| | - Obinna O Adibe
- 3 Division of Pediatric Surgery, Duke University Medical Center , Durham, North Carolina
| | - Henry E Rice
- 3 Division of Pediatric Surgery, Duke University Medical Center , Durham, North Carolina
| | - Elisabeth T Tracy
- 3 Division of Pediatric Surgery, Duke University Medical Center , Durham, North Carolina
| |
Collapse
|
9
|
Predictors of gastrostomy placement in children with inherited metabolic diseases treated by umbilical cord blood transplantation. J Pediatr Surg 2015; 50:1109-11. [PMID: 25783333 DOI: 10.1016/j.jpedsurg.2014.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE Children with inherited metabolic diseases (IMDs) undergoing umbilical cord blood transplantation (UCBT) who are at risk for post-transplant failure to thrive may benefit from pretransplant gastrostomy tube (GT) placement. Here we sought to determine predictors of posttransplant failure to thrive. METHODS A retrospective analysis was performed for IMD patients who underwent UCBT at a single center from 2001 to 2011. Patients who received GTs were compared with controls. Multivariable logistic regression was used to determine significant predictors for GT placement. Recursive partitioning was performed to determine appropriate cut-offs for significant continuous variables. RESULTS Two hundred and seventeen patients met inclusion criteria of which twenty-three were excluded due to death within one hundred days of transplant. Forty (20.6%) of the remaining patients underwent a surgical GT placement. Multivariable logistic regression demonstrated that weight percentile at time of transplant was significantly associated with GT placement (Adjusted odds ratio (AOR): 0.87 per 10th percentile, p=0.022). Recursive partitioning demonstrated that the 40th weight percentile at time of transplant was an optimal cut-off for predicting GT placement. CONCLUSIONS Patients preparing for umbilical cord transplantation who are below the 40th percentile for weight may benefit from pre-emptive GT placement prior to transplant.
Collapse
|
10
|
Baker L, Beres AL, Baird R. A systematic review and meta-analysis of gastrostomy insertion techniques in children. J Pediatr Surg 2015; 50:718-25. [PMID: 25783383 DOI: 10.1016/j.jpedsurg.2015.02.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 02/13/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Gastrostomy tubes are inserted via multiple techniques to provide a route for enteral feeding in the pediatric population. This review compares the rate of major complications and resource utilization associated with the various insertion techniques. METHODS Major electronic databases were queried for comparative studies of two or more insertion techniques, including open, laparoscopic, percutaneous endoscopic, or fluoroscopic guided. Major complications were defined as reoperation within 1 year or death. Screening of eligible studies, data extraction, and assessment of methodological quality were conducted independently by two reviewers. Forest and funnel plots were generated for outcomes using Revman 5.1, with p<0.05 considered significant. RESULTS Twenty-two studies with a total of 5438 patients met inclusion criteria. No differences in major complications were noted in studies comparing open versus laparoscopic approaches or open versus PEG. Studies comparing laparoscopic gastrostomy and PEG revealed a significantly increased risk in major complications with PEG (n=10 studies, OR 0.29, 95% CI: 0.17-0.51, p<0.0001). The number needed to treat to reduce one major complication by abandoning PEG is 45. CONCLUSIONS PEG is associated with an increased risk of major complications when compared to the laparoscopic approach. Advantages in operative time appear outweighed by the increased safety profile of laparoscopic gastrostomy insertion.
Collapse
Affiliation(s)
| | - Alana L Beres
- Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada; McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Baird
- Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada; McGill University Health Centre, Montreal, Quebec, Canada.
| |
Collapse
|
11
|
Papandria D, Goldstein SD, Salazar JH, Cox JT, McIltrot K, Stewart FD, Arnold M, Abdullah F, Colombani P. A randomized trial of laparoscopic versus open Nissen fundoplication in children under two years of age. J Pediatr Surg 2015; 50:267-71. [PMID: 25638616 DOI: 10.1016/j.jpedsurg.2014.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/02/2014] [Indexed: 11/25/2022]
Abstract
AIMS The surgery of gastroesophageal reflux disease (GERD) is common in modern pediatric surgical practice. Any differences in perioperative and long-term clinical outcomes following laparoscopic (LN) or open Nissen (ON) fundoplication have not been comprehensively described in young children. This randomized, prospective study examines outcomes following LN versus ON in children<2 years of age. METHODS Four surgeons at a single institution enrolled patients under 2 years of age that required surgical management of GERD, who were then randomized to LN or ON between 2005 and 2012. A universal surgical dressing was employed for blinding. Analgesia and enteral feeding pathways were standardized. The primary outcome was postoperative length of stay. Perioperative outcomes and long-term follow up were collected as secondary outcomes and used to compare groups. RESULTS Of 39 enrolled patients, 21 were randomized to ON and 18 to LN. Length of postoperative hospital stay, time of advancement to full enteral feeds, and analgesic requirements were not significantly different between treatment cohorts. The LN group experienced longer median operating times (173 vs 91 min, P<0.001) and higher surgical charges ($4450 vs $2722, P=0.002). The incidence of post-discharge complications did not differ significantly between the groups at last follow-up (median 42 months). CONCLUSIONS This randomized trial comparing postoperative outcomes following LN vs ON did not detect statistically significant differences in short- or long-term clinical outcomes between these approaches. LN was associated with longer surgical time and higher operating room costs. The benefits, risks, and costs of laparoscopy should be carefully considered in clinical pediatric surgical practice.
Collapse
Affiliation(s)
- Dominic Papandria
- Department of Surgery, St. Vincent Indianapolis Hospital, Indianapolis USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore USA.
| | - Jose H Salazar
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore USA
| | - Jacob T Cox
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore USA
| | - Kimberly McIltrot
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore USA
| | - F Dylan Stewart
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore USA
| | - Meghan Arnold
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore USA
| | - Paul Colombani
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore USA
| |
Collapse
|
12
|
Leung L, Wong CWY, Chung PHY, Wong KKY, Tam PKH. Laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease in infants. Pediatr Surg Int 2015; 31:83-8. [PMID: 25348879 DOI: 10.1007/s00383-014-3629-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Data on laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease (GERD) in infants remain limited. We describe our experience with this operation in children and in particular, infants younger than 12 months old. MATERIALS AND METHODS Medical records of all paediatric patients who had laparoscopic fundoplication done for GERD from 1998 to 2013 were reviewed. Patients were divided into two groups based on age: group I: 0-12 months, and group II >12 months. Data on indications, patient's demographics, operative time, blood loss, conversions, complications, recurrences and duration of hospitalization were studied. RESULTS A total of 86 patients were reviewed (group I, n = 21; group II, n = 65). While the mean age and body weight for group I were 8 ± 2.99 months and 6 ± 1.96 kg, the values for group II were 98 ± 65 months and 18 ± 9.6 kg, respectively. All patients had concurrent laparoscopic gastrostomy for feeding difficulties. The mean operative time was shorter in group I (157 ± 55 vs 169 ± 52 min, p = 0.66). Both groups had minimal blood loss only. The surgical outcomes in both groups were comparable in terms of recurrence (0 vs 3 %, p = 0.105) and complications (9.5 vs 6 %, p = 0.275). The median follow-up duration for group I and group II was 23 and 40 months, respectively. Sixteen (76 %) patients in group I and 45 (67 %) patients in group II did not develop pneumonia post fundoplication. CONCLUSION Laparoscopic Nissen fundoplication can be safely performed in infants with outcomes comparable to older patients and a shorter operative duration. Low recurrence rate (up to 3 %) is shown by our long term follow-up data. We recommend laparoscopic Nissen fundoplication to be considered in managing infants with GERD.
Collapse
Affiliation(s)
- Ling Leung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | | | | | | | | |
Collapse
|
13
|
Comparison of long-term outcomes between open and laparoscopic Thal fundoplication in children. J Pediatr Surg 2014; 49:1069-74. [PMID: 24952790 DOI: 10.1016/j.jpedsurg.2014.02.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 02/03/2014] [Accepted: 02/15/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES In recent years laparoscopic fundoplication is increasingly performed in pediatric surgery. The aim of this study was to compare the long-term outcomes between open and laparoscopic Thal fundoplication in children. METHODS This retrospective study includes children who underwent a Thal fundoplication between 3/1997 and 7/2009. The minimum follow-up time to enter the study was 2 years; the overall median follow-up was 77 months (range, 29-176 months). RESULTS A total of 101 patients were included, of which 47 underwent an open and 54 a laparoscopic Thal. Intraoperative problems, early postoperative complications, time to establish enteral feeds and length of stay did not differ among both groups. The mean duration of surgery was significantly less in the open group (OPG) (108.0 (± 7.72) versus 144.1 (± 6.36) minutes; p=0.001) and this was mainly attributed to patients with neurological problems. Severe dysphagia requiring endoscopy was observed in 10 patients, but this did not differ significantly between groups (n=2 in the OPG vs. n=8 in the laparoscopic group (LAPG); p=0.10). Overall 12 patients (11.9%) (6 in each group) required a redo-fundoplication after a median of 18.7 months (range, 6-36 months). In the whole study group, 80 patients (79.2%) were classified as having surgical results being excellent, good or satisfactory and this did not differ significantly between groups. CONCLUSIONS In the long-term open and laparoscopic Thal fundoplication have similarly good outcomes. The laparoscopic approach can be considered as an alternative, however there is not a clear superiority compared with the open counterpart.
Collapse
|
14
|
Cheng AW, Shaul DB, Lau ST, Sydorak RM. Laparoscopic Redo Nissen Fundoplication After Previous Open Antireflux Surgery in Infants and Children. J Laparoendosc Adv Surg Tech A 2014; 24:359-61. [DOI: 10.1089/lap.2013.0464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amy W. Cheng
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Donald B. Shaul
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Stanley T. Lau
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Roman M. Sydorak
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| |
Collapse
|
15
|
Gulack BCH, Adibe OO. Laparoscopic antireflux surgery in infants with single ventricle physiology: a review. J Laparoendosc Adv Surg Tech A 2013; 23:733-7. [PMID: 23859741 DOI: 10.1089/lap.2013.0076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laparoscopic fundoplication and gastrostomy tube placement have grown in popularity within the pediatric population for treatment of gastroesophageal reflux disease and failure to thrive, respectively. One population that has an increased need for gastric surgery in infancy is patients with congenital heart defects, especially those with "single ventricle physiology." The most common defect included in this population is hypoplastic left heart syndrome (HLHS). Because of the abnormal physiology present in this condition, there are concerns with regard to the use of laparoscopic procedures for gastric surgery in patients treated with a three-staged reconstruction. We review the staged reconstruction of infants with HLHS, address safety concerns of interstage noncardiac procedures on this patient population, and review the current literature regarding outcomes of laparoscopic gastric surgery on patients with single ventricle physiology.
Collapse
Affiliation(s)
- Brian C H Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | |
Collapse
|
16
|
Gillory LA, Megison ML, Harmon CM, Chen MK, Anderson S, Chong AJ, Chaignaud BE, Beierle EA. Laparoscopic surgery in children with congenital heart disease. J Pediatr Surg 2012; 47:1084-8. [PMID: 22703774 DOI: 10.1016/j.jpedsurg.2012.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The study aim was to determine outcomes of children with congenital heart disease who underwent laparoscopic procedures. METHODS A single-institution, institutional review board-approved, retrospective review was conducted including children younger than 5 years with congenital heart disease who underwent laparoscopic or open abdominal procedures. Patient demographics, operative details, complications, and 30-day mortality were examined. RESULTS Over 10 years, 111 children with congenital heart disease underwent 121 laparoscopic procedures. Median age was 2.5 months, with 87% being infants. Laparoscopic gastrostomy was the most common procedure (101). There was no intraoperative hemodynamic instability, median operative time was 70 minutes, postoperative complications were low (5%), and all children were alive at 30 days. Only 8 patients required conversion from laparoscopic to open, all secondary to technical issues, not hemodynamic instability. There were 42 children with cardiac disease who underwent 45 open procedures during the study period. There were no significant differences between patient demographics, type of procedure, operative time, complications, or 30-day mortality comparing the open and laparoscopic groups. CONCLUSION In this review, there were no major contraindications to performing laparoscopic procedures in children with congenital heart disease, and we conclude that it is reasonably safe to perform laparoscopic surgery on these children.
Collapse
|
17
|
Rothenberg S, Cowles R. The effects of laparoscopic Nissen fundoplication on patients with severe gastroesophageal reflux disease and steroid-dependent asthma. J Pediatr Surg 2012; 47:1101-4. [PMID: 22703777 DOI: 10.1016/j.jpedsurg.2012.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND An association between severe reactive airway disease (RAD) and gastroesophageal reflux disease (GERD) in children has been previously noted, but the relationship has not been well characterized. This study reports our experience with laparoscopic Nissen fundoplication and its effect on the pulmonary status of children with severe steroid-dependent RAD. METHODS Between January 1993 and June 2011, 235 patients with severe steroid-dependent RAD and medically refractory GERD underwent laparoscopic Nissen fundoplication. Clinical response, ability to wean oral and inhaled steroids, and changes in pulmonary function testing were tracked during the postoperative period. RESULTS Of 235 patients, 215 (91%) noted significant subjective improvement in their respiratory symptoms by the first postoperative visit at 2 weeks. Eighty percent was successfully weaned off their oral steroids within the first 2 postoperative months. Ninety-five percent reported a decrease in their inhaler use. Twenty-four percent of patients studied had a documented increase in their forced expiratory volume in the initial postoperative period. There were no intraoperative complications and no postoperative respiratory tract infections. CONCLUSION Children with steroid-dependent RAD and documented GERD refractory to medical management show improvement in their respiratory status after laparoscopic Nissen fundoplication. Many can be weaned off of their oral and inhaled steroids postoperatively.
Collapse
|
18
|
Singh S, Verma R, Pandey A, Tandon C, Wakhlu A, Agarwal A. Laparoscopic surgery in a paediatric patient with Down's syndrome and patent foramen ovale. BMJ Case Rep 2011; 2011:bcr.09.2010.3334. [PMID: 22691594 DOI: 10.1136/bcr.09.2010.3334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The safety of laparoscopic surgery in infants with congenital heart disease has been a subject of controversy despite potential benefits over open surgery. The authors present the anaesthetic management of a 6-month-old female infant with Down's syndrome with a small patent foramen ovale with left to right shunt who successfully underwent laparoscopic coloplasty. There were no intraoperative or postoperative complications. In addition to the routine anaesthetic considerations for any surgical patient, the choice of the anaesthetic technique in patients undergoing laparoscopic procedures should consider the effect on the patient's underlying cardiorespiratory function of pneumoperitoneum and carbon dioxide insufflation.
Collapse
Affiliation(s)
- Sarita Singh
- Department of Anesthesiology, CSMMU (formerly King George's Medical University), Lucknow, India
| | | | | | | | | | | |
Collapse
|
19
|
Siddiqui MRS, Abdulaal Y, Nisar A, Ali H, Hasan F. A meta-analysis of outcomes after open and laparoscopic Nissen's fundoplication for gastro-oesophageal reflux disease in children. Pediatr Surg Int 2011; 27:359-66. [PMID: 20734053 DOI: 10.1007/s00383-010-2698-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 12/22/2022]
Abstract
The objective of this study is to meta-analyse the published literature comparing outcomes after open (ONF) versus laparoscopic Nissen fundoplication (LNF) for gastro-oesophageal reflux disease in children. Electronic databases were searched from January 1993 to October 2009. A systematic review was performed to obtain a summative outcome. Six comparative studies were analysed. There were 466 patients in the laparoscopic group and 255 in the open group. There was no significant difference in operative time between LNF compared with ONF (p = 0.35). Children stayed in hospital for less time after undergoing LNF compared with ONF [random effects model: SMD = 0.93, 95% CI (0.41, 1.44), z = 3.53, p < 0.01]. Children feed earlier after LNF [random effects model: SMD = 4.13, 95% CI (1.00, 7.27), z = 2.58, p < 0.001] and had less morbidity [fixed effects model: RR = 3.22, 95% CI (1.98, 5.25), z = 4.71, p < 0.01; random effects model: RR = 2.90, 95% CI (1.49, 5.66), z = 3.12, p < 0.01]. No difference in recurrence at 12 months was highlighted (p = 0.29). In conclusion, the laparoscopic Nissen's fundoplication in children may be considered a safe and effective alternative to open surgery; however, careful case selection is required.
Collapse
|
20
|
Rhee D, Zhang Y, Chang DC, Arnold MA, Salazar-Osuna JH, Chrouser K, Colombani PM, Abdullah F. Population-based comparison of open vs laparoscopic esophagogastric fundoplication in children: application of the Agency for Healthcare Research and Quality pediatric quality indicators. J Pediatr Surg 2011; 46:648-654. [PMID: 21496532 DOI: 10.1016/j.jpedsurg.2010.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Increasing national focus on patient safety has promoted development of the pediatric quality indicators (PDIs), which screen for preventable events during provision of health care for children. Our objective is to apply these safety metrics to compare 2 surgical procedures in children, specifically laparoscopic and open esophagogastric fundoplication for gastroesophageal reflux. METHODS A retrospective analysis using 20 years of data from national representative state inpatient databases through the Healthcare Cost and Utilization Project was conducted. Patients younger than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for open or laparoscopic esophagogastric fundoplication were included. Pediatric quality indicators were linked to each patient's profile. Demographics, comorbidities, outcomes, and 8 selected PDIs between open and laparoscopic fundoplications were compared using Pearson χ(2) tests and t tests. RESULTS Of 33,533 patients identified, 28,141 underwent open and 5392 underwent laparoscopic fundoplication. Comorbidities occurred more frequently in open surgery. In-hospital mortality, length of stay, and hospital charges were less in laparoscopic surgery. Of the 8 PDIs evaluated, decubitus ulcer (P = .04) and postoperative sepsis (P = .003) had decreased rates with laparoscopic surgery compared with open. CONCLUSION Laparoscopic fundoplication for gastroesophageal reflux in children can be performed safely compared with the open approach with equivalent or improved rates of PDIs.
Collapse
Affiliation(s)
- Daniel Rhee
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA
| | - Yiyi Zhang
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA
| | - David C Chang
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA
| | - Meghan A Arnold
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA
| | - Jose H Salazar-Osuna
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA
| | - Kristin Chrouser
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA
| | - Paul M Colombani
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, MD 21287-0005, USA.
| |
Collapse
|
21
|
Shah SR, Jegapragasan M, Fox MD, Prince JM, Segura BJ, Kane TD. A review of laparoscopic Nissen fundoplication in children weighing less than 5 kg. J Pediatr Surg 2010; 45:1165-8. [PMID: 20620313 DOI: 10.1016/j.jpedsurg.2010.02.078] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 02/22/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Minimally invasive procedures in small infants and neonates are being performed in increasing numbers. In this study, we describe our institution's experience with laparoscopic Nissen fundoplications (LNFs) in children weighing less than 5 kg. METHODS All cases of LNF attempted in children weighing less than 5 kg since January 2003 at a tertiary-care pediatric hospital were reviewed after Institutional Review Board approval. RESULTS One hundred twenty-two children weighing less than 5 kg underwent LNF during the study period. They ranged from 2 weeks to 3 years of age (mean, 94 +/- 61.3 days) and weighed 1.94 to 4.99 kg (mean, 3.68 +/- 0.77 kg). Twenty-nine percent (n = 35) were neurologically impaired. Eighty-eight percent (n = 107) had concurrent gastrostomy tube placement. Eight (7%) were converted to laparotomy. The average operative time was 112 +/- 46 minutes. Seventy-one percent (n = 87) required intensive care unit use for an average of 14.3 +/- 17.4 days. The average time to start enteral feeds was 2.6 +/- 2.6 days. Thirty-one percent (n = 38) required postoperative mechanical ventilation for an average of 12.0 +/- 20.6 days. The average hospital length of stay was 36.6 +/- 36.0 days (range, 3-175 days). Six patients (5%) had a complication or recurrent gastroesophageal reflux. Three patients had recurrent reflux, one of which underwent another LNF. One patient had a gastric perforation. Another required a redo LNF after a disrupted wrap was noted at a recurrent hiatal hernia repair. Lastly, one patient had bleeding from an accessory hepatic artery with liver retractor placement. CONCLUSIONS Laparoscopic Nissen fundoplication can safely and effectively be performed in small children (<5 kg) with similar outcomes and rates of complication as previously published reports in larger children. These children, however, do have prolonged intensive care unit and mechanical ventilation use associated with their prematurity and significant comorbidities.
Collapse
Affiliation(s)
- Sohail R Shah
- Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
| | | | | | | | | | | |
Collapse
|
22
|
Curtis JL, Wong G, Gutierrez I, Gollin G. Pledgeted mattress sutures reduce recurrent reflux after laparoscopic Nissen fundoplication. J Pediatr Surg 2010; 45:1159-64. [PMID: 20620312 DOI: 10.1016/j.jpedsurg.2010.02.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 02/22/2010] [Indexed: 01/08/2023]
Abstract
INTRODUCTION In response to a perceived increase in the incidence of recurrent reflux after adopting the laparoscopic Nissen fundoplication, we adjusted our technique to include the use of pledgeted, horizontal mattress sutures for crural closure and wrap construction. METHODS We assessed the impact of this technical modification in children who underwent laparoscopic fundoplication between 1997 and 2007 at a large children's hospital. The medical history, indications, technical details, and outcomes were reviewed. Differences between groups were assessed with chi(2), logistic regression, and Kaplan-Meier analysis. RESULTS A total of 384 subjects were identified. Neurologic deficits were present in 77%. The crural closure and wrap were constructed with simple sutures in 226 and with pledgeted, horizontal mattress sutures in 158. The cumulative incidences of recurrent reflux, gagging/retching, wrap failure on imaging studies, and reoperation were significantly greater with the use of simple sutures (P < .01, .03, < .01, and < .01, respectively). Kaplan-Meier analysis confirmed a significant difference in the probability of recurrent reflux with simple sutures despite a significant difference in postoperative follow-up. Operative time was the same with both methods. CONCLUSIONS The use of pledgeted, horizontal mattress sutures for crural closure and wrap construction in laparoscopic Nissen fundoplication may reduce the incidence of recurrent reflux.
Collapse
Affiliation(s)
- Jennifer L Curtis
- Division of Pediatric Surgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
| | | | | | | |
Collapse
|
23
|
A comparison of laparoscopic and open Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit population. J Pediatr Surg 2010; 45:346-9. [PMID: 20152349 DOI: 10.1016/j.jpedsurg.2009.10.073] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 10/27/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The aim of this study was to compare outcomes after laparoscopic and open techniques for Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit (NICU) population. METHODS The medical records for NICU inpatients who underwent laparoscopic and open Nissen fundoplication and gastrostomy placement from August 2002 to August 2008 were reviewed after Institutional Review Board approval. Each technique was compared with regard to operative time, estimated blood loss, postoperative 24-hour narcotic requirements, time to goal feeds, and complication rates. Analysis of variance was used to determine statistical significance. Data are quoted as mean +/- SEM. RESULTS Fifty-seven NICU patients underwent fundoplication and gastrostomy placement (25 laparoscopic and 32 open). The time to goal feeds was significantly shorter for the laparoscopic group (4.3 +/- 0.4 vs 6.1 +/- 0.6 days, P = .04). The 24-hour postoperative narcotic requirement was significantly lower in the laparoscopic group (0.24 +/- 0.05 vs 0.55 +/- 0.08 mg/kg, P = .007). Operation times (111 +/- 5 [open] vs 113 +/- 5 minutes, P = .76) and estimated blood loss (13 +/- 2 [open] vs 11 +/- 1 mL, P = .33) were comparable for both groups. CONCLUSION Laparoscopic and open techniques for Nissen fundoplication with gastrostomy placement are safe and appropriate treatment methods with equivalent operating times for the treatment of gastroesophageal reflux in the NICU population.
Collapse
|
24
|
IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:x-xiii. [PMID: 19371153 DOI: 10.1089/lap.2009.9982.supp] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
25
|
Holder-Murray J, Statter MB, Liu D. Bowel Obstruction Secondary to Internal Hernia after Laparoscopic Nissen Fundoplication and Gastrostomy Tube Placement. Am Surg 2009. [DOI: 10.1177/000313480907501227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
26
|
IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A 2009; 19:x-xiii. [PMID: 19226225 DOI: 10.1089/lap.2009.9998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
-
- International Pediatric Endosurgery Group (IPEG), Los Angeles, CA 90064, USA.
| |
Collapse
|
27
|
IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD). J Laparoendosc Adv Surg Tech A 2009; 18:x-xiii. [PMID: 19105663 DOI: 10.1089/lap.2008.9988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
28
|
Kerem M, Salman B, Pasaoglu H, Bedirli A, Alper M, Katircioglu H, Atici T, Perçin EF, Ofluoglu E. Effects of microalgae chlorella species crude extracts on intestinal adaptation in experimental short bowel syndrome. World J Gastroenterol 2008; 14:4512-7. [PMID: 18680231 PMCID: PMC2731278 DOI: 10.3748/wjg.14.4512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effects of chlorella crude extract (CCE) on intestinal adaptation in rats subjected to short bowel syndrome (SBS).
METHODS: Wistar rats weighing 230-260 g were used in the study. After anesthesia a 75% small bowel resection was performed. Rats were randomized and divided into groups. Control group (n = 10): where 5% dextrose was given through a gastrostomy tube, Enteral nutrition (EN) group (n = 10): Isocaloric and isonitrogen EN (Alitraq, Abbott, USA), study group (n = 10): CCE was administrated through a gastrostomy tube. Rats were sacrificed on the fifteenth postoperative day and blood and tissue samples were taken. Histopathologic evaluation, intestinal mucosal protein and DNA levels, intestinal proliferation and apoptosis were determined in intestinal tissues, and total protein, albumin and citrulline levels in blood were studied.
RESULTS: In rats receiving CCE, villus lengthening, crypt depth, mucosal DNA and protein levels, intestinal proliferation, and serum citrulline, protein and albumin levels were found to be significantly higher than those in control group. Apoptosis in CCE treated rats was significantly reduced when compared to EN group rats.
CONCLUSION: CCE has beneficial effects on intestinal adaptation in experimental SBS.
Collapse
|
29
|
Doi T, Ichikawa S, Miyano G, Lane GJ, Miyahara K, Yamataka A. A New Technique for Preventing Wrap Disruption/Migration After Laparoscopic Nissen Fundoplication: An Experimental Study. J Laparoendosc Adv Surg Tech A 2008; 18:179-82. [DOI: 10.1089/lap.2007.0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takashi Doi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoko Ichikawa
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Go Miyano
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Geoffrey J. Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsumi Miyahara
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
30
|
Saedon M, Gourgiotis S, Germanos S. Is there a changing trend in surgical management of gastroesophageal reflux disease in children? World J Gastroenterol 2007; 13:4417-22. [PMID: 17724795 PMCID: PMC4611572 DOI: 10.3748/wjg.v13.i33.4417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimated that approximately one in every 350 children will experience severe symptomatic gastroesophageal reflux necessitating surgical treatment. Surgery for GORD is currently one of the common major operations performed in infants and children. Most of the studies found favour laparoscopic approach which has surpassed open antireflux surgery as the gold standard of surgical management for GORD. However, it must be interpreted with caution due to the limitation of the studies, especially the small number of subject included in these studies. This review reports the changing trends in the surgical treatment of GORD in children.
Collapse
Affiliation(s)
- Mahmud Saedon
- Department of General Surgery, Leighton Hospital, Cheshire, UK
| | | | | |
Collapse
|
31
|
Rothenberg SS. Laparoscopic redo Nissen fundoplication in infants and children. Surg Endosc 2006; 20:1518-20. [PMID: 16902749 DOI: 10.1007/s00464-005-0123-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 10/02/2005] [Indexed: 11/30/2022]
Abstract
From January 1994 to December 2004, 118 patients with recurrent gastroesophageal reflux disease (GERD) after fundoplication underwent laparoscopic redo Nissen fundoplication. The patients ranged in age from 6 months to 19 years (mean, 7 years), and weighed from 6.4 to 85 kg. Of the 118 patients, 64 had previous open fundoplications, 53 had previous laparoscopic fundoplications, and 19 had more than one previous fundoplication. All the procedures had been successfully completed laparoscopically. The average operative time was 100 min. The intraoperative complication rate was 1.1%. The average time to full feeding was 1.8 days, and the average hospital stay was 2.2 days. The postoperative complication rate was 3.6%. The wrap failure rate during an average follow-up period of 48 months was 6%. Laparoscopic redo Nissen fundoplication for a failed antireflux procedure is a safe and effective procedure. It has the same benefits as a primary laparoscopic Nissen for GERD, with low morbidity and a quicker recovery. Early follow-up evaluation suggests that the long-term outcome is superior to that associated with open redo fundoplication.
Collapse
Affiliation(s)
- S S Rothenberg
- The Mother and Child Hospital at Presbyterian/St Lukes, Denver, CO, USA
| |
Collapse
|
32
|
Roumm AR, Pizzi L, Goldfarb NI, Cohn H. Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures. Surg Innov 2006; 12:261-87. [PMID: 16224649 DOI: 10.1177/155335060501200313] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.
Collapse
Affiliation(s)
- Adam R Roumm
- Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA
| | | | | | | |
Collapse
|
33
|
Diaz DM, Gibbons TE, Heiss K, Wulkan ML, Ricketts RR, Gold BD. Antireflux surgery outcomes in pediatric gastroesophageal reflux disease. Am J Gastroenterol 2005; 100:1844-52. [PMID: 16086723 DOI: 10.1111/j.1572-0241.2005.41763.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Antireflux surgery is performed frequently in children with gastroesophageal reflux disease (GERD). Few comparative studies exist which assess the indications for and short- or long-term outcome of open Nissen fundoplication (ONF) and laparoscopic Nissen fundoplication (LNF) for pediatric GERD. We investigated the frequency of reoperation and factors that might influence its occurrence. METHODS We performed a retrospective, follow up cohort study of all children </=5 years, who underwent LNF or ONF at our institution from January 1, 1997 to December 31, 2002, where five pediatric surgeons perform fundoplication. Mean follow up time was 36.2 months. The following information was obtained: surgical indications, hospital course data, and long-term surgical outcomes. Data were analyzed using univariate and multiple logistic regressions. RESULTS Overall, 456 (150 [32.9%] ONF vs. 306 [67.1%] LNF) cases were analyzed. Reoperation was performed in 55 (12.06%), LNF 43 (14.05%), and ONF 12 (8%). The mean interim to reoperation for LNF was 11 months compared to 17 months for ONF (p= 0.007). The reoperation rate at 12 and 24 months were 10.5%, 13.4% and 4%, 6.7% respectively, when LNF was compared to ONF (p= 0.01). The multivariate analysis showed that initial LNF and prematurity were the main predictors for reoperation. CONCLUSIONS The majority of reoperations for both LNF and ONF occurred in the first year after initial operation; LNF had a significantly higher reoperation rate than ONF. The probability of reoperation for LNF and ONF increases with the presence of comorbidities, especially prematurity and chronic respiratory conditions.
Collapse
Affiliation(s)
- Diego M Diaz
- Pediatric Gastroenterology and Nutrition, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | | | | | | | | | | |
Collapse
|
34
|
Mariano ER, Boltz MG, Albanese CT, Abrajano CT, Ramamoorthy C. Anesthetic Management of Infants with Palliated Hypoplastic Left Heart Syndrome Undergoing Laparoscopic Nissen Fundoplication. Anesth Analg 2005; 100:1631-1633. [PMID: 15920186 DOI: 10.1213/01.ane.0000149899.03904.3f] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The safety of laparoscopic surgery in infants with single ventricle physiology has been a subject of controversy despite potential benefits over open surgery. We present the anesthetic management of five infants with palliated hypoplastic left heart syndrome that underwent laparoscopic Nissen fundoplication. After anesthetic induction and tracheal intubation, an intraarterial catheter was placed for hemodynamic monitoring. Insufflation pressure was limited to 12 mm Hg and was well tolerated by all patients. There were no intraoperative or postoperative complications. In patients with hypoplastic left heart syndrome, laparoscopic Nissen fundoplication can be safely performed with careful patient selection and close intraoperative monitoring.
Collapse
Affiliation(s)
- Edward R Mariano
- Department of Anesthesia, University of California at San Diego School of Medicine, San Diego, California; Department of Anesthesia, Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California
| | | | | | | | | |
Collapse
|
35
|
Rothenberg SS. The first decade's experience with laparoscopic Nissen fundoplication in infants and children. J Pediatr Surg 2005; 40:142-6; discussion 147. [PMID: 15868575 DOI: 10.1016/j.jpedsurg.2004.09.031] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Fundoplication for gastroesophageal reflux disease is a common procedure performed in infants and children. This report describes over a 10-year experience with more than 1000 consecutive laparoscopic Nissen fundoplications. METHODS Ages ranged from 5 days to 18 years and weight from 1.2 to 120 kg. The procedures were performed using a 5 trocar technique and with 5- or 3-mm instruments depending on the size of the patient. Of 1050 fundoplications, 1048 were completed successfully through laparoscopy. RESULTS Average operative time dropped dramatically from 109 minutes for the first 30 cases compared with 38 minutes for the last 30. Intraoperative and postoperative complications were 0.26% and 4.0%, respectively. Average time to discharge post fundoplication was 1.1 days. The wrap failure rate is 4.0%. CONCLUSIONS This study shows in a large operative experience for 10 years that laparoscopic fundoplication is safe and effective in the pediatric population. Clinical results are comparable to the traditional open fundoplication but with a significant decrease in morbidity and hospitalization.
Collapse
Affiliation(s)
- Steven S Rothenberg
- The Mother and Child Hospital at Presbyterian/St Luke's Medical Center, Denver, CO 80218, USA.
| |
Collapse
|
36
|
von Schweinitz D, Till H. Chirurgie des gastroösophagealen Refluxes im Kindesalter. Monatsschr Kinderheilkd 2004. [DOI: 10.1007/s00112-004-1008-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
37
|
Lintula H, Antila P, Kokki H. Laparoscopic fundoplication in children with a preexisting gastrostomy. J Laparoendosc Adv Surg Tech A 2004; 13:381-5. [PMID: 14733702 DOI: 10.1089/109264203322656450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Children with a gastrostomy may require laparoscopic fundoplication (LF). METHODS Children with a gastrostomy who underwent LF between 1998 and 2002 were reviewed. The outcomes of children undergoing LF were compared with a group of children without a gastrostomy who had the same operation during the same period. RESULTS Ten children with a gastrostomy in place and eight children without a gastrostomy underwent LF. The median operating time was 198 minutes (range, 115-300 minutes) in the gastrostomy group and 110 minutes (range, 80-130 minutes) in the non-gastrostomy group (P =.002). In the gastrostomy group, two children had ventriculoperitoneal shunts and two had extensive intra-abdominal adhesions due to peritonitis. One laparoscopic procedure in each group was converted to an open approach. A successful LF was performed in nine of the ten children without taking down the gastrostomy. One child with a gastrostomy experienced recurrent vomiting that was managed with a gastrojejunal tube. One child in the non-gastrostomy group required reoperation due to an esophageal stricture. CONCLUSION It seems that LF can be performed safely and effectively in children with a preexisting gastrostomy. LF in children with a gastrostomy seems to be as efficacious as LF in children without a gastrostomy.
Collapse
Affiliation(s)
- Hannu Lintula
- Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland.
| | | | | |
Collapse
|
38
|
Chen LE, Minkes RK, Langer JC. Laparoscopic versus Open Surgery for Malrotation Without Volvulus. ACTA ACUST UNITED AC 2003. [DOI: 10.1089/109264103322614312] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
39
|
Abstract
Gastroesophageal reflux is common in infants and generally resolves spontaneously within the first year of life as the lower esophageal sphincter mechanism matures. The reflux is only considered a "disease" (GERD) when it becomes symptomatic or causes pathological consequences. GERD is commonly associated with esophageal atresia and there is a high incidence in neurologically impaired children; in both groups conservative treatment is notoriously ineffective. The diagnosis of GER is made on upper gastrointestinal contrast studies, endoscopy and pH monitoring. Medical management comprises antacids, reduction of gastric acid production and prokinetic agents. The indications for antireflux surgery include an established esophageal stricture, associated anatomical defect and failure of medical therapy. Apnoeic episodes secondary to documented GER in the infant, constitute an absolute indication for early surgery.
Collapse
Affiliation(s)
- L Spitz
- Department of Paediatric Surgery, Institute of Child Health, University College London and Great Ormond Street Hospital for Children, UK
| | | |
Collapse
|
40
|
Bourne MC, Wheeldon C, MacKinlay GA, Munro FD. Laparoscopic Nissen fundoplication in children: 2-5-year follow-up. Pediatr Surg Int 2003; 19:537-9. [PMID: 13680291 DOI: 10.1007/s00383-003-0985-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2003] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to document the current status of a cohort of children who underwent laparoscopic fundoplication at a single centre between 1996 and 1998. METHODS Parents were contacted and a questionnaire regarding preoperative and current symptoms completed. Case notes were reviewed for results of postoperative investigations. RESULTS Forty-five laparoscopic Nissen fundoplications were performed. The median age was 5 years. Twenty-eight children were neurologically impaired. Five died of underlying medical problems during follow-up. Two were lost to follow-up, leaving 38 parents interviewed. Median follow-up was 36 months. Twenty-five children were asymptomatic, and 13 reported upper gastrointestinal symptoms. In ten, symptoms were less severe than preoperatively. Nine of the 13 children were taking acid suppressing drugs. No children reported problems with dysphagia. Twelve of the 13 symptomatic children had investigations for recurrent reflux. In no case was there evidence of reflux or wrap disruption. One of the children who died had been demonstrated to have recurrent reflux on barium swallow. CONCLUSIONS Sixty-six percent of patients reported complete relief, and a further 26% reported considerable improvement of their symptoms. There was a high degree of parental satisfaction with the outcome of the operation. The results suggest that laparoscopic fundoplication is a durable procedure with documented recurrent reflux in only 2% of children at a median follow-up of 3 years.
Collapse
Affiliation(s)
- M C Bourne
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK
| | | | | | | |
Collapse
|
41
|
Powers CJ, Levitt MA, Tantoco J, Rossman J, Sarpel U, Brisseau G, Caty MG, Glick PL. The respiratory advantage of laparoscopic Nissen fundoplication. J Pediatr Surg 2003; 38:886-91. [PMID: 12778386 DOI: 10.1016/s0022-3468(03)00116-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Laparoscopic Nissen fundoplication is replacing the open approach in the treatment of children with gastroesophageal reflux. The postoperative respiratory advantages seem obvious but remain unproven. The authors hypothesized that laparoscopic Nissen fundoplication provides postoperative respiratory advantages in neurologically normal children as well as those with mental retardation or profound neurologic impairment. METHODS The charts of all laparoscopic Nissen fundoplications over a 4-year period were reviewed. Sixty-one laparoscopic procedures were compared with the most recent 61 consecutive open Nissen fundoplications. The following variables were reviewed: age, weight, gender, preexisting comorbidities, operating time, postoperative pulmonary complications, and length of stay. Categorical data were compared for significance utilizing chi2 cross tabulation. Variables representing numerical data were compared by t test. RESULTS Although there appeared to be a trend toward sicker patients in the open group, the laparoscopic group showed significantly improved rates of extubation, shorter recovery room stays, shorter durations of chest physiotherapy, fewer intensive care unit admissions, more rapid resumption of baseline feedings, and overall decreased length of stay (P < 0.05). Pulmonary benefits also were noted in the neurologically impaired population when analyzed separately. CONCLUSIONS Laparoscopic Nissen fundoplication confers a definable benefit with a significant pulmonary advantage in both neurologically normal children and those with neurologic impairment.
Collapse
Affiliation(s)
- Colin J Powers
- Department of Pediatric Surgical Services and the Miniature Access Surgery Center, Children's Hospital of Buffalo, Buffalo, NY 14222, USA
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Mattioli G, Repetto P, Carlini C, Torre M, Pini Prato A, Mazzola C, Leggio S, Montobbio G, Gandullia P, Barabino A, Cagnazzo A, Sacco O, Jasonni V, PiniPrato A. Laparoscopic vs open approach for the treatment of gastroesophageal reflux in children. Surg Endosc 2002; 16:750-2. [PMID: 11997815 DOI: 10.1007/s00464-001-9040-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2001] [Accepted: 10/04/2001] [Indexed: 12/19/2022]
Abstract
BACKGROUND The laparoscopic approach has become increasingly popular for fundoplication over the last few years; however many surgeons are skeptical about its real advantages. METHODS We conducted a prospective comparative study of children operated on for gastroesophageal reflux (GER). Exclusion criteria included age <1 YEAR AND >14 years, previous surgery on the esophagus or stomach, and neurologic impairment. We compared two groups of patients who met the same inclusion/exclusion criteria. One group was treated via a laparotomic approach between January 1993 and December 1997; the other was treated via a laparoscopic approach between September 1998 and December 2000. A 360 degrees wrap was performed in each group. RESULTS Group 1 (laparotomic approach) included 17 patients; mean operative time was 100 min and postoperative time was 7 days. Group 2 comprised 49 children operated on via a laparoscopic approach; mean operative time was 78 min and postoperative time was 48 hours. No major complications were encountered in either group. In postoperative period, two patients in group 1 had complications. One had a prolonged bout of gastroplegia, which required nasogastric drainage, and then recovered spontaneously after 20 days; the other had stenosis of the wrap, which required dilation. No relapses occurred during a follow-up of 6 months. Long-term follow-up data are not presented. Comparative analysis of the short-term functional results indicated that there were no differences between the two groups. CONCLUSION This study confirms that the minimally invasive approach is safe and effective for the treatment of primary gastroesophageal reflux disease in children.
Collapse
Affiliation(s)
- G Mattioli
- Department of Pediatric Surgery, Giannina Gaslini Research Institute and University of Genoa, Largo G. Gaslini 5, 16100 Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Iglesias JL, Kogut K, Owings E, Rothenberg S, Schropp K, Georgeson K, Lobe TE. Safety and Efficacy of Laparoscopic Nissen Fundoplication in Early Infancy. ACTA ACUST UNITED AC 2001. [DOI: 10.1089/10926410152776360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- José L. Iglesias
- Divisions of Pediatric Surgery, University of Tennessee and LeBonheur Children's Hospital, Memphis, Tennessee
| | - Kelly Kogut
- Divisions of Pediatric Surgery, University of Tennessee and LeBonheur Children's Hospital, Memphis, Tennessee
| | - Elizabeth Owings
- Division of Pediatric Surgery, University of Alabama and The Children's Hospital of Alabama, Birmingham, Alabama
| | - Steven Rothenberg
- Division of Pediatric Surgery, Hospital for Infants and Children at Presbyterian/St. Luke's Medical Center, Denver, Colorado
| | - Kurt Schropp
- Divisions of Pediatric Surgery, University of Tennessee and LeBonheur Children's Hospital, Memphis, Tennessee
| | - Keith Georgeson
- Division of Pediatric Surgery, University of Alabama and The Children's Hospital of Alabama, Birmingham, Alabama
| | - Thom E Lobe
- Divisions of Pediatric Surgery, University of Tennessee and LeBonheur Children's Hospital, Memphis, Tennessee
| |
Collapse
|
44
|
Orenstein SR, Di Lorenzo C. Postfundoplication Complications in Children. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2001; 4:441-449. [PMID: 11560791 DOI: 10.1007/s11938-001-0009-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The optimal "treatment" of postfundoplication complications is preoperative prevention of them. Nonreflux causes of the symptom prompting surgery should be carefully eliminated preoperatively. Failure to respond to optimal powerful antireflux pharmacotherapy suggests that GERD was not the cause of symptoms. Neurologic or respiratory disease, delayed gastric emptying or retching, short esophagus, and esophageal dysmotility may predispose patients to complications, and may require careful tailoring of the fundoplication. The optimal antireflux surgery, with a wrap neither too loose nor too tight, may require a nadir lower esophageal sphincter pressure of more than 5 mm Hg to prevent reflux, but less than some value to prevent dysphagia. This latter value may be approximately 10 mm Hg, but depends on swallowing parameters such as peristaltic pressure, lower esophageal sphincter opening diameter, swallowed bolus diameter, and other considerations. Infants may require a gastrostomy tube for venting because of their lower gastric compliance to deal with swallowed air. Children with delayed gastric emptying may benefit from pyloroplasty, but this is debated. When complications occur, re-evaluate the diagnosis and the competence of the fundoplication with barium fluoroscopy, endoscopy with histology, pH probe, and other modalities as indicated. Initially try conservative management of the patient's complications, including dietary and feeding modifications. Give a trial of antireflux pharmacotherapy for recurrent reflux or pharmacotherapy directed at the specific side-effect of the fundoplication if one is present. Consider endoscopically dilating a persistently tight wrap or surgically revising the fundoplication if it is suggested by the evaluation.
Collapse
Affiliation(s)
- Susan R. Orenstein
- Pediatric Gastroenterology, Children's Hospital of Pittsburgh, One Children's Place, Pittsburgh, PA 15213-2583, USA.
| | | |
Collapse
|
45
|
Liu DC, Wynn RA, Rodriguez JA, Hill CB, Loe WA. Laparoscopic Nissen–Rossetti Fundoplication in Children. ACTA ACUST UNITED AC 2001. [DOI: 10.1089/109264101300009112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Donald C. Liu
- Children's Hospital of New Orleans, New Orleans, Louisiana
| | - R. Alex Wynn
- Children's Hospital of New Orleans, New Orleans, Louisiana
| | | | | | - William A. Loe
- Children's Hospital of New Orleans, New Orleans, Louisiana
| |
Collapse
|
46
|
Liu DC, Flattmann GJ, Karam MT, Siegrist BI, Loe WA, Hill CB. Laparoscopic fundoplication in children with previous abdominal surgery. J Pediatr Surg 2000; 35:334-7. [PMID: 10693691 DOI: 10.1016/s0022-3468(00)90035-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE In our institution, many children requiring antireflux surgery for gastroesophageal reflux have had previous abdominal surgery, usually gastrostomy tube or ventriculoperitoneal (VP) shunt placement. The authors review their laparoscopic Nissen fundoplication (LNF) experience in children with previous abdominal surgery assessing surgical outcome. METHODS A total of 82 consecutive LNFs performed at our institution between January 1996 and September 1998 were reviewed. Follow-up ranged from 1 month to 32 months (average, 8.9 months). LNF was performed without dividing short gastric vessels (Rosetti modification) through a standard 5-port technique. RESULTS A total of 26 of 82 patients (31.7%) had previous abdominal surgery and were divided into 2 groups: gastrostomy (n = 17) and VP shunt (n = 11) with 2 crossovers. A total of 14 of 17 (82.3%) in the gastrostomy group had percutaneous endoscopic gastrostomy (PEG) placement versus 3 of 17 (17.6%) by open technique (open). Four patients in the VP group had multiple surgeries (range, 1 to 10, average, 2.3). LNF was completed in 25 of 26 (96.2%). One operation was converted to an open procedure because of severe adhesions. In 13 of 17 (76.5%) the previous gastrostomy was not taken down. In 4 of 17 (23.5%), the gastrostomy was taken down to complete the procedure: 2 of 3 (66.7%) of the open group versus 2 of 14 (14.3%) of the PEG group. All 11 (100%) of the VP group had successful LNF. Two of 11 (18.2%) had shunt dysfunction at 2 months (shunt infection) and 4 months (clogged distal shunt), respectively. There have been no cases of recurrent reflux, and all gastrostomies and VP shunts were functional at the time of this report. CONCLUSIONS Previous abdominal surgery is common in children with gastroesophageal reflux disease requiring an antireflux procedure. The authors conclude from these preliminary results that laparoscopic Nissen fundoplication can be performed safely with minimal morbidity and excellent functional results in children with gastrostomies or ventriculoperitoneal shunts.
Collapse
Affiliation(s)
- D C Liu
- Children's Hospital of New Orleans, LA 70118, USA
| | | | | | | | | | | |
Collapse
|
47
|
Kowatari K, Suzuki K, Kudo S, Yamada M, Liu Q, Danjo K, Umeda T, Nakaji S, Sugawara K. Applicability of chemiluminescence to assess the degree of operative stress in patients undergoing spinal surgery. LUMINESCENCE 1999; 14:331-4. [PMID: 10602303 DOI: 10.1002/(sici)1522-7243(199911/12)14:6<331::aid-bio556>3.0.co;2-e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study examined the applicability of luminol-dependent chemiluminescence (CL) response of neutrophils to assess the degree of stress of spinal surgery by measuring the capacity of circulating neutrophils to produce reactive oxygen species and the levels of serum cytokines: interleukin(IL)-1beta, IL-6, IL-8, tumour necrosis factor (TNF)-alpha and granulocyte colony stimulating factor (G-CSF). Ten male patients underwent spinal surgery. Peripheral blood samples, collected before and after the operation and the next morning, were used for measuring the CL response of neutrophils stimulated with opsonized zymosan and measuring the levels of serum cytokines. The operative stress induced leukocytosis, particularly granulocytosis, and increased serum IL-6 and G-CSF significantly. However, there was no significant change in the luminol-dependent CL response of neutrophils or the levels of serum IL-1beta, IL-8 and TNF-alpha throughout the experimental period. These results suggest that, at least in the early postoperative period, operative stress does not prime the circulating neutrophils, and thus the CL response of neutrophils is not appropriate to assess the degree of stress of spinal surgery.
Collapse
Affiliation(s)
- K Kowatari
- Department of Hygiene, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
The use of minimally invasive surgery in patients with cancer is slowly evolving. There are a number of reports describing laparoscopy in adults for pancreatic, ovarian, gastric, and colon cancers. In addition, thoracoscopy has been described for lung and esophageal cancers. The role of laparoscopy and thoracoscopy in children with cancer is less clear because a number of pediatric neoplasms are sensitive to adjuvant therapy and surgery is often part of a planned multi-dimensional approach. This article describes a previous reported experience with minimally invasive surgery in children with cancer, current indications for this approach, and general principles which are important regarding the operative technique. In addition, future applications for this technology are suggested.
Collapse
Affiliation(s)
- G W Holcomb
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212-1586, USA.
| |
Collapse
|
49
|
STEYAERT H, ORDORICA-FLORES R, MERROT T, VALLA J. Learning Curve in Laparoscopic Fundoplication in Children. ACTA ACUST UNITED AC 1999. [DOI: 10.1089/pei.1999.3.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
50
|
Abstract
The surgeon should be aware of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide surgical care in association with either outpatient or short-stay hospitalizations appear to be cost-effective and appropriate state-of-the-art medical care. Because the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will continue to become increasingly available.
Collapse
Affiliation(s)
- T E Lobe
- Section of Pediatric Surgery, University of Tennessee, Memphis, USA
| |
Collapse
|