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Berman L, Baird R, Sant'Anna A, Rosen R, Petrini M, Cellucci M, Fuchs L, Costa J, Lester J, Stevens J, Morrow M, Jaszczyszyn D, Amaral J, Goldin A. Gastrostomy Tube Use in Pediatrics: A Systematic Review. Pediatrics 2022; 149:186999. [PMID: 35514122 DOI: 10.1542/peds.2021-055213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Despite frequency of gastrostomy placement procedures in children, there remains considerable variability in preoperative work-up and procedural technique of gastrostomy placement and a paucity of literature regarding patient-centric outcomes. OBJECTIVES This review summarizes existing literature and provides consensus-driven guidelines for patients throughout the enteral access decision-making process. DATA SOURCES PubMed, Google Scholar, Medline, and Scopus. STUDY SELECTION Included studies were identified through a combination of the search terms "gastrostomy," "g-tube," and "tube feeding" in children. DATA EXTRACTION Relevant data, level of evidence, and risk of bias were extracted from included articles to guide formulation of consensus summaries of the evidence. Meta-analysis was conducted when data afforded a quantitative analysis. EVIDENCE REVIEW Four themes were explored: preoperative nasogastric feeding tube trials, decision-making surrounding enteral access, the role of preoperative imaging, and gastrostomy insertion techniques. Guidelines were generated after evidence review with multidisciplinary stakeholder involvement adhering to GRADE methodology. RESULTS Nearly 900 publications were reviewed, with 58 influencing final recommendations. In total, 17 recommendations are provided, including: (1) tTrial of home nasogastric feeding is safe and should be strongly considered before gastrostomy placement, especially for patients who are likely to learn to eat by mouth; (2) rRoutine contrast studies are not indicated before gastrostomy placement; and (3) lLaparoscopic placement is associated with the best safety profile. LIMITATIONS Recommendations were generated almost exclusively from observational studies and expert opinion, with few studies describing direct comparisons between GT placement and prolonged nasogastric feeding tube trial. CONCLUSIONS Additional patient- and family-centric evidence is needed to understand critical aspects of decision-making surrounding surgically placed enteral access devices for children.
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Affiliation(s)
- Loren Berman
- Departments of Surgery.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Baird
- Department of Pediatric General and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana Sant'Anna
- Department of Pediatrics, Division of Gastroenterology and Nutrition, McGill University Health Center, Montreal, Quebec, Canada
| | - Rachel Rosen
- Aerodigestive Center, Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts
| | - Maria Petrini
- Pediatrics.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Cellucci
- Pediatrics.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lynn Fuchs
- Neonatology.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joanna Costa
- Neonatology.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lester
- Nutrition.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jenny Stevens
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Michele Morrow
- Therapy Services, Nemours Children's Health, Wilmington, Delaware.,Sidney Kimmel Medical School at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Joao Amaral
- Department of Diagnostic Imaging, Division of Interventional Radiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Goldin
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
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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.
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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
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Jacobson JC, Pandya SR. A narrative review of gastroesophageal reflux in the pediatric patient. Transl Gastroenterol Hepatol 2021; 6:34. [PMID: 34423155 DOI: 10.21037/tgh-20-245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/12/2020] [Indexed: 11/06/2022] Open
Abstract
Gastroesophageal reflux (GER) is the retrograde passage of gastric contents into the esophagus. It is a physiologic condition that is common in neonates, typically resolves spontaneously, and does not result in clinically significant complications. When pathologic, gastroesophageal reflux disease (GERD) can cause numerous complications including persistent emesis, failure to thrive, aspiration, and respiratory symptoms. While a diagnosis can often be made from a thorough history and physical, some patients may require further testing. In general, many clinicians will reserve extensive investigation such as multiple intraluminal impedance and pH monitoring for patients with a confounding clinical picture or relative contraindications to medical or surgical management. Whereas most pediatric GER resolves spontaneously, medical management including lifestyle changes, changes to feeds, and the use of H2-antagonists and/or proton pump inhibitors (PPIs) can be utilized to alleviate symptoms. Surgical treatment is reserved for patients who are refractory to medical management or have suffered significant complications as a consequence of GER. In this article we seek to provide a concise but detailed review of recent updates in the understanding, work up and management of GER in the pediatric patient. A summary of new technologies used in the diagnostic and therapeutic arms of this disease are included.
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Affiliation(s)
| | - Samir R Pandya
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
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Concomitant gastrostomy tube insertion during laparoscopic Nissen fundoplication for gastro-esophageal reflux disease: analysis of risk factors for fundoplication failure. Surg Endosc 2020; 35:4251-4258. [PMID: 32833100 DOI: 10.1007/s00464-020-07913-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laparoscopic Nissen fundoplication (LNF) and gastrostomy tube (GT) placement may be performed concomitantly in children with gastro-esophageal reflux disease (GERD) and failure to thrive. We aimed to evaluate the rate and risk factors for LNF failure in children undergoing concomitant LNF/GT. METHODS A retrospective multi-institutional cohort study was conducted, reviewing patients that underwent LNF (2005-2014). Data collected included patient demographics, comorbidities, and type of GT (laparoscopy- or endoscopy-assisted). The primary outcome measure was LNF failure. Data was compared using contingency tables or Mann-Whitney tests, when appropriate. An exploratory analysis by Kaplan-Meier survival and Cox proportional hazards analysis was performed to determine predictors of time to LNF failure after LNF/GT. RESULTS Of 189 children that underwent LNF, 99 (52%) had a concomitant GT (55% laparoscopy-, 45% endoscopy-assisted). LNF failed in 15% after LNF/GT and in 17% after LNF alone (p = 0.84), at a median age of 23 months (IQR 8-41). Using univariate analysis, we found that a younger age at the time of surgery (p = 0.05), prematurity (p = 0.0018), esophageal atresia (p = 0.01), and endoscopy-assisted GT (p = 0.02) were potential predictors of LNF failure after LNF/GT. After multivariate regression analysis, prematurity (p = 0.007) remained significantly associated with LNF failure after LNF/GT. No predictive factors for LNF failure after LNF alone were identified. CONCLUSIONS Concomitant GT insertion and LNF is a common practice, as half of the children that undergo LNF also received GT insertion. Children born preterm or with esophageal atresia comprise a fragile population at high-risk of LNF failure after LNF/GT. Prospective, multicentric studies are needed to evaluate the best GT technique to use in children undergoing LNF.
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Gezer HÖ, Ezer SS, Temiz A, İnce E, Hiçsönmez A. Boix-Ochoa (Partial Fundoplication) Treats Reflux, Even in Neurologically Impaired Patients. Can it Take the Title of "Gold Standard" from Total Fundoplication? J Gastrointest Surg 2019; 23:2338-2345. [PMID: 30887292 DOI: 10.1007/s11605-019-04179-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/22/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 4-5% of cases of gastroesophageal reflux disease (GERD), surgical treatment is required. The aim of the study was to evaluate the success of Boix-Ochoa antireflux surgery, which is considered more physiologic with a higher failure rate (need for reoperation) than Nissen fundoplication, which is believed to be the gold standard operation. METHOD In the 13 years from 2005 to 2018, the medical records of all children who underwent Boix-Ochoa in a single institution by pediatric surgeons were reviewed retrospectively. RESULTS A total of 133 fundoplications were performed, of which patients were divided into four groups: neurologically impaired, structurally impaired, neurologically and structurally impaired, and neurologically and structurally normal; there were 64, 8, 34, and 27 patients in each group, respectively. Structural impairments included hiatal hernia and esophagus atresia, having previously had a gastrostomy and esophageal stenosis. The most common short-term complication was distal esophageal stenosis (13%), which caused vomiting and dysphagia, and was treated by dilatations. There were six (4.5%) recurrences of GER, one in the neurologically and structurally impaired group with a hiatal hernia and five in the structurally impaired group (three esophagus atresias, two caustic esophageal strictures). The mean follow-up period was 5.27 ± 3.43 years. Neurological impairment did not affect the success rate. CONCLUSION Although there has not any literature demonstrating significant benefits of one procedure, we detected with this largest study in the pediatric literature about Boix-Ochoa fundoplication (more physiologic and easily performed) that it was successful (95%) in protecting reflux even in neurologically impaired patients (98%). We consider Boix-Ochoa (partial fundoplication) to be an alternative method to Nissen (complete fundoplication), and it can be done safely with a high success rate.
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Affiliation(s)
- Hasan Özkan Gezer
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Gazipaşamahallesi Barajcaddesi No: 7, Seyhan, 01250, Adana, Turkey.
| | - Semire Serin Ezer
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Gazipaşamahallesi Barajcaddesi No: 7, Seyhan, 01250, Adana, Turkey
| | - Abdulkerim Temiz
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Gazipaşamahallesi Barajcaddesi No: 7, Seyhan, 01250, Adana, Turkey
| | - Emine İnce
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Gazipaşamahallesi Barajcaddesi No: 7, Seyhan, 01250, Adana, Turkey
| | - Akgün Hiçsönmez
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Gazipaşamahallesi Barajcaddesi No: 7, Seyhan, 01250, Adana, Turkey
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Williams K, Baumann L, Abdullah F, Hendrickson RJ, Oyetunji TA. Elective laparoscopic gastrostomy in children: potential for an enhanced recovery protocol. Pediatr Surg Int 2019; 35:643-647. [PMID: 30915530 DOI: 10.1007/s00383-019-04472-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastrostomy tube placement is one of the most commonly performed pediatric surgical procedures and discharge is possible as early as the first postoperative day with early initiation of feeds postoperatively. We examined a national database to determine hospital length of stay (LOS) after elective laparoscopic gastrostomy in children. METHODS We queried the 2012-2013 National Surgical Quality Improvement Program Pediatric (NSQIP-P) database, including all patients who underwent elective laparoscopic gastrostomy tube placement for failure to thrive or feeding difficulties. Demographic data, admission status, disposition at discharge, surgical subspecialty data and hospital LOS were extracted. RESULTS A total of 599 patients underwent gastrostomy tube placement for failure to thrive or feeding intolerance. The majority, 52%, was male and 69.3% were White. The median age was 2.2 years (IQR 0.9-6.3). Of the total, 28.7% were infants. The median total hospital LOS was 2 days (IQR 1-2), with only 39% discharged in a day or less. CONCLUSION Pediatric patients undergoing elective laparoscopic gastrostomy have a median hospital length of stay of 2 days, despite evidence that early feeding and discharge within 24 h is both feasible and safe. There is potential for the implementation of an enhanced recovery protocol as a quality metric for this procedure.
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Affiliation(s)
- Kibileri Williams
- Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Lauren Baumann
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Fizan Abdullah
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611, USA
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Rosales A, Whitehouse J, Laituri C, Herbello G, Long J. Outcomes of laparoscopic nissen fundoplications in children younger than 2-years: single institution experience. Pediatr Surg Int 2018; 34:749-754. [PMID: 29808280 DOI: 10.1007/s00383-018-4281-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Variation exists in the diagnostic testing for gastroesophageal reflux (GER) in infants and in the application of surgical therapy. There has been an increase in antireflux surgery (ARS) since the development of laparoscopy but the outcomes in high-risk infants is unclear. This study examines the results of laparoscopic fundoplication in infants less than 2 years. METHODS The results of infants less than 2 years undergoing laparoscopic Nissen fundoplication (Lap-F) from 2012 to 2015 were retrospectively reviewed and outcomes were followed until 2017. RESULTS There were 106 patients, median gestational age 32.50 weeks ± 6.35 SD and non-corrected age at operation 23.0 weeks ± 19.0 SD, mean weight of 4.81 kg ± 2.10 SD. One of the most common reasons for surgical consultation was improvement in respiratory status after insertion of nasoduodenal feeding tube. Of the Lap-F, 100 were with gastrostomy tube (GT). There were no conversions to open or intraoperative complications. The complication rate was 4.71%, and the reoperation rate was 5.66%, one fundoplication revision and the others gastrostomy revisions. The median time for feeds and to reach goal were 1 (1-14) and 4 (2-279) days, respectively. The 30-day mortality was 0.9% and long-term it was 4.71%. The long-term mortality was related to the underlying medical problems. The median follow-up was 113 (3-286) weeks. One patient required revision of the fundoplication and none required esophageal dilatation during the follow-up period. CONCLUSION Fundoplication is effective for relief of symptoms of GER in children younger than 2 years. The procedure has a low morbidity and mortality in this population.
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Affiliation(s)
- Armando Rosales
- Department of Surgery, Cleveland Clinic Florida, Weston, USA
| | - Jill Whitehouse
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Carrie Laituri
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Glenda Herbello
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Julie Long
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA.
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Lei X, Ren Q, Yang Y, Bai T. Outcome Evaluation of Laparoscopic and Open Nissen Fundoplication in Children—A Systematic Review and Meta-Analysis. Am Surg 2017. [DOI: 10.1177/000313481708300131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Our aim was to estimate the efficacy of laparoscopic and open Nissen fundoplication (ONF) in the treatment of gastroesophageal reflux disease (GERD) in children. An electronic systematic review of the published literature was conducted in Cochrane Library, MEDLINE (PubMed), and EmBase in October 2015 in English and without time restrictions. The participants, interventions, and comparisons in the clinical question translated directly into eligibility criteria for study inclusion and exclusion. Study information extraction and methodological quality assessments were accomplished by two reviewers independently. Methodological quality was assessed by using the “Criteria for judging risk of bias in the ‘Risk of bias’ assessment tool.” Odds ratio (OR) with 95 per cent confidence interval was computed as summary statistics. Fixed-effects model was used and a pooled OR was calculated with the Mantel–Haenszel method initially. If the studies were heterogeneous, then the DerSimonian and Laird random effects model was used for meta-analysis. Outcome indices included mortality of patients, recurrence of GERD, reoperation of GERD, patients with complications, length of postoperative hospital stay, and surgery duration of laparoscopic Nissen fundoplication (LNF) and ONF. Statistical analyses were carried out by using Review Manager 5.2. The duration of follow-up varied between two days and four years. Children operated with LNF had a higher recurrence rate of GERD than those undergoing ONF. The pooled OR of LNF versus ONF was 2.98 (95% confidence interval = 1.29–6.87) while the heterogeneity was I2 = 47 per cent and P = 0.13. Statistical analysis showed that there was no significant difference for mortality, reoperation, and complication. The mean duration of surgery was significantly longer in the LNF than the ONF group while the results of length of postoperative hospital stay remained inconformity. In this meta-analysis, children operated with LNF had a higher recurrence rate of GERD than those undergoing ONF. Meanwhile, when considering the outcomes of mortality, reoperation, and complications, there was no significant difference. The mean duration of surgery was significantly longer in the LNF than the ONF group while no consistent conclusion of length of postoperative hospital stay was found.
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Affiliation(s)
- Xing Lei
- Departments of General Surgery, Yan'an University Affiliated Hospital, Yan'an, PR China
| | - Qingquan Ren
- Departments of Thoracic Surgery, Yan'an University Affiliated Hospital, Yan'an, PR China
| | - Yang Yang
- Departments of Thoracic Surgery, Yan'an University Affiliated Hospital, Yan'an, PR China
| | - Tiecheng Bai
- Departments of Thoracic Surgery, Yan'an University Affiliated Hospital, Yan'an, PR China
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Ru W, Wu P, Feng S, Lai XH, Chen G. Laparoscopic versus open Nissen fundoplication in children: A systematic review and meta-analysis. J Pediatr Surg 2016; 51:1731-6. [PMID: 27516174 DOI: 10.1016/j.jpedsurg.2016.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/05/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To systematically review and meta-analyze studies that have compared the clinical outcomes of laparoscopic and open Nissen fundoplication on children. METHODS Online databases were searched to identify studies that have compared the laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF) on children, looking specifically for operative time, time to full feed, redo fundoplication rates and total postoperative complications including wound infection, retching, and airway complications. RESULTS Of those 916 patients in the 9 selected studies, 557 and 359 patients had undergone LNF and ONF, respectively; and LNF had significant longer operative time and less total postoperative complications including retching and airway complications than ONF. However, no significant difference in time to full feed, wound infection, and redo fundoplication rates was found between LNF and ONF in children. CONCLUSION LNF is a safe, feasible, and effective surgical procedure alternative to ONF for gastroesophageal reflux in children. Compared with ONF, LNF has the advantage of less total postoperative complications including retching and airway complications. In addition, LNF is comparable to ONF in terms of time to full feed, wound infection, and redo fundoplication rates. Therefore, we conclude that LNF should be regarded as an acceptable option for children.
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Affiliation(s)
- Wei Ru
- Department of Urology and Oncology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Peng Wu
- Department of Pediatric Surgery, Northwest Women and Children's Hospital (Shaanxi Provincial Maternity Hospital), Xi'an, Shaanxi, China
| | - Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng District, Hangzhou, China
| | - Xin-He Lai
- Institute of Inflammation and Diseases, Institute of Translational Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guorong Chen
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Desai AA, Alemayehu H, Dalton BG, Gonzalez KW, Biggerstaff B, Holcomb GW, St. Peter SD. Review of the Experience with Re-Operation After Laparoscopic Nissen Fundoplication. J Laparoendosc Adv Surg Tech A 2016; 26:140-3. [DOI: 10.1089/lap.2015.0273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amita A. Desai
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Hanna Alemayehu
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Brian G. Dalton
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | - George W. Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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11
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Iwanaka T, Yamataka A, Uemura S, Okuyama H, Segawa O, Nio M, Yoshizawa J, Yagi M, Ieiri S, Uchida H, Koga H, Sato M, Soh H, Take H, Hirose R, Fukuzawa H, Mizuno M, Watanabe T. Pediatric Surgery. Asian J Endosc Surg 2015; 8:390-407. [PMID: 26708583 DOI: 10.1111/ases.12263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/25/2022]
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12
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Berman L, Sharif I, Rothstein D, Hossain J, Vinocur C. Concomitant fundoplication increases morbidity of gastrostomy tube placement. J Pediatr Surg 2015; 50:1104-8. [PMID: 25783337 DOI: 10.1016/j.jpedsurg.2014.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/23/2014] [Accepted: 07/27/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fundoplication is often performed in conjunction with gastrostomy tube (GT) placement in children, but there is a great deal of variation in rates of and indications for this procedure. Little is known about the impact of fundoplication on peri-operative outcomes. This study examines a national cohort of pediatric patients to compare risk-adjusted surgical outcomes in patients undergoing GT placement with or without concomitant fundoplication. METHODS We identified all patients undergoing GT placement in the 2012 National Surgical Quality Improvement Program - Pediatric. We evaluated demographics, comorbidities, complications, and length of stay for GT with fundoplication versus GT alone. We defined composite morbidity as a dichotomous variable for the presence of any complication. Logistic regression was performed to identify predictors of morbidity after adjusting for covariates. RESULTS 1289 GT patients were identified, and 148 (11.5%) underwent concurrent fundoplication. The fundoplication patients were more likely to be younger, have cardiac risk factors, and be on respiratory support. They also had higher rates of surgical site infection (7.4% vs 3.7%, p=0.03) and composite morbidity (16.9% vs 8.7%, p=0.001), and longer LOS (median 5 vs 3 days, p=<0.0001) compared to GT only. After adjusting for covariates, fundoplication was a predictor of composite morbidity and increased LOS. CONCLUSION Concomitant fundoplication is an independent risk factor for 30-day post-operative morbidity in patients undergoing GT placement. These findings do not negate the value of fundoplication but underscore the importance of careful patient selection, and should be taken into consideration when discussing risks and benefits with families.
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Affiliation(s)
- Loren Berman
- Nemours-A.I. duPont Hospital for Children, Wilmington, DE.
| | - Iman Sharif
- Nemours-A.I. duPont Hospital for Children, Wilmington, DE
| | - David Rothstein
- Division of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY
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13
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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.
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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.
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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.
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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
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15
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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.
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Affiliation(s)
- Ling Leung
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
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16
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Lacher M, Kuebler JF, Dingemann J, Ure BM. Minimal invasive surgery in the newborn: current status and evidence. Semin Pediatr Surg 2014; 23:249-56. [PMID: 25459008 DOI: 10.1053/j.sempedsurg.2014.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The evolution of minimally invasive surgery (MIS) in the newborn has been delayed due to the limited working space and the unique physiology. With the development of smaller instruments and advanced surgical skills, many of the initial obstacles have been overcome. MIS is currently used in specialized centers around the world with excellent feasibility. Obvious advantages include better cosmesis, less trauma, and better postoperative musculoskeletal function, in particular after thoracic procedures. However, the aim of academic studies has shifted from proving feasibility to a critical evaluation of outcome. Prospective randomized trials and high-level evidence for the benefit of endoscopic surgery are still scarce. Questions to be answered in the upcoming years will therefore include both advantages and potential disadvantages of MIS, especially in neonates. This review summarizes recent developments of MIS in neonates and the evidence for its use.
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Affiliation(s)
- Martin Lacher
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany.
| | - Joachim F Kuebler
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
| | - Jens Dingemann
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
| | - Benno M Ure
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
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17
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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.
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Sharp NE, Thomas P, St Peter SD. Single-incision laparoscopic ileocecectomy in children with Crohn's disease. J Laparoendosc Adv Surg Tech A 2014; 24:589-92. [PMID: 24918784 DOI: 10.1089/lap.2013.0517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION We previously reported our experience with standard laparoscopic ileocecectomy, but we have recently used a single-incision laparoscopic approach. PATIENTS AND METHODS We conducted a retrospective review of a single surgeon's experience from 2009 to 2013. RESULTS Twenty-eight children 11-18 years of age (mean, 15.5 years) with a mean body mass index of 18.9±3 kg/m(2) underwent single-incision laparoscopic ileocecectomy for Crohn's disease. Mean operative time was 86.5±25.9 minutes (range, 56-166 minutes). There were no extra ports placed or conversions to open surgery. Five children (18%) were on parenteral nutrition at time of surgery, 14 (50%) were on steroids, and 9 (32%) were on tumor necrotic factor inhibitors. A stapled extracorporeal anastomosis was performed in all children. Complications included abscess (n=4), small bowel obstruction (n=3), superficial wound infection (n=3), and small bowel perforation (n=1). Some patients had more than one complication. Of those with complications, 5 (56%) were on steroids, 5 (56%) were on tumor necrotic factor inhibitors, and 1 patient was on both. The perforation occurred at a point of adhesiolysis also involved with Crohn's disease. There were no anastomotic leaks. Median follow-up was 17 months (range, 1-47 months). CONCLUSIONS Single-incision laparoscopic ileocecectomy is safe and feasible in pediatric patients with Crohn's disease.
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Affiliation(s)
- Nicole E Sharp
- Department of Surgery, The Children's Mercy Hospital , Kansas City, Missouri
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McGrath-Morrow SA, Hayashi M, Aherrera AD, Collaco JM. Respiratory outcomes of children with BPD and gastrostomy tubes during the first 2 years of life. Pediatr Pulmonol 2014; 49:537-43. [PMID: 24039081 PMCID: PMC4088273 DOI: 10.1002/ppul.22870] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Infants with bronchopulmonary dysplasia (BPD) often undergo gastrostomy tube (GT) placement and/or Nissen fundoplication (Nissen) to improve weight gain and to attenuate chronic respiratory symptoms related to feeding difficulties. After initial hospitalization little is known how these children do with regard to respiratory symptoms when compared to children with BPD who did not receive GTs. This study was done to determine if differences in respiratory outcomes were associated with the presence of a GT or Nissen/GT in children with BPD during the first 2 years of life. METHODS Children (n = 398) were recruited from the Johns Hopkins BPD Outpatient Clinic. Medical charts were reviewed and acute care usage and respiratory symptoms were assessed by caregiver questionnaires. RESULTS Ninety-two children with BPD had GTs, with the majority placed by 6 months of age. Of children with GTs, 64.7% also had Nissen fundoplication. Children with Nissen/GTs were more likely to have birth weights <10th percentile and to be discharged on supplemental oxygen. After initial hospitalization, children with GTs and Nissen/GTs weaned off supplemental oxygen at significantly older ages than children without GTs. Children with Nissen/GTs also had more hospitalizations than children without GTs. Caregivers of children with GTs and Nissen/GTs reported similar respiratory symptoms as caregivers of children without GTs. CONCLUSION Weaning off supplemental oxygen occurred later in children with GTs and Nissen/GTs compared to children without GTs. Although children with Nissen/GTs had more re-hospitalizations, there were no differences in reported respiratory symptoms between any of the groups by caregiver questionnaire.
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Affiliation(s)
- Sharon A McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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20
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Persistent gastrocutaneous fistula: factors affecting the need for closure. J Pediatr Surg 2013; 48:2506-10. [PMID: 24314194 DOI: 10.1016/j.jpedsurg.2013.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/31/2013] [Accepted: 06/05/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE The occurrence of gastrocutaneous fistula (GCF) is a well-known complication after gastrostomy tube placement. We explore multiple factors to ascertain their impact on the rate of persistent GCF formation. METHODS We retrospectively reviewed patient records for all gastrostomies (GT) constructed at our institution from 2007 to 2011. Association of GCF with method of placement, concomitant fundoplication, neurologic findings, duration of therapy, and demographics was evaluated using logistic regression. RESULTS Nine hundred fifty patients had GTs placed, of which 148 patients had GTs removed and 47 (32%) of 148 required surgical closure secondary to persistent GCF. Laparoscopic and open procedures comprised 79 (53%) of 148 and 69 (47%) of 148, respectively. Seventeen (22%) patients in the laparoscopic group developed persistent GCF, compared to 30 (43%) in the open group (P=0.035, OR=2.52). Seventy-one patients had concomitant Nissen fundoplication. Thirty-one (44%) developed GCF, compared to 16 (21%) without a Nissen (P=0.002, OR=4.94). Patients with button in place for 303 days had persistent GCF incidence of 23%, compared to 45% at 540 days (P<0.001, OR=3.51) and 50% at 850 days (P=0.011, OR=4.51). Patients with device placed at 1.8 months of age were more likely to develop GCF compared to those with device placed at 8.9 months of age (P=0.017, OR=2.35). CONCLUSION Open operations, concurrent Nissen and younger age at placement were all statistically significant factors causing persistent GCF.
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Abstract
PURPOSE OF REVIEW Gastroesophageal reflux (GER) remains a common, challenging problem for clinicians, with differentiation of normal development from disease a particular issue. This review updates clinicians on advances in diagnosis of GER, relationship to other problems, and current practice in management. RECENT FINDINGS Development and understanding of multichannel intraluminal impedance-pH monitoring has given insights into the relationship of GER to symptoms. Medical treatment has changed little. Avoidance of overmedicalizing normal development is the major issue for clinicians. Laparoscopic fundoplication is established as equivalent to open fundoplication. Newer endoscopic techniques have only limited use in children to date. SUMMARY Major changes in pediatric GER relate to understanding of physiology and relationship of GER to symptoms. The major challenge for clinicians involve differentiation of normal from abnormal GER, and applying the most relevant management.
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22
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Castle SL, Speer AL, Torres MB, Anselmo DM, Nguyen NX. Combined Laparoscopic-Endoscopic Placement of Primary Gastrojejunal Feeding Tubes in Children: A Preliminary Report. J Laparoendosc Adv Surg Tech A 2013; 23:170-3. [DOI: 10.1089/lap.2012.0243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
| | | | - Manuel B. Torres
- Children's Hospital Los Angeles, Los Angeles, California
- Miller Children's Hospital, Long Beach, California
| | - Dean M. Anselmo
- Children's Hospital Los Angeles, Los Angeles, California
- Miller Children's Hospital, Long Beach, California
| | - Nam X. Nguyen
- Children's Hospital Los Angeles, Los Angeles, California
- Miller Children's Hospital, Long Beach, California
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23
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Knatten CK, Fyhn TJ, Edwin B, Schistad O, Emblem R, Bjørnland K. Thirty-day outcome in children randomized to open and laparoscopic Nissen fundoplication. J Pediatr Surg 2012; 47:1990-6. [PMID: 23163988 DOI: 10.1016/j.jpedsurg.2012.05.038] [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: 02/22/2012] [Revised: 04/18/2012] [Accepted: 05/24/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laparoscopic Nissen fundoplication (LNF) is considered by some to be superior to open Nissen fundoplication (ONF). To test this hypothesis, we compared early results after LNF and ONF in a randomized trial. METHODS All children accepted for antireflux surgery for gastroesophageal reflux disease were offered enrollment. Ethical approval and parental consent were obtained. Anesthesia, surgical methods, and postoperative treatment were standardized. Patient demographics, length of hospital stay (LOS), and complications occurring the first 30 postoperative days were registered. RESULTS Eighty-eight children were randomized to LNF (n = 44) or ONF (n = 44). The groups were comparable with regard to age, weight, and comorbidity. Duration of surgery was 150 ± 34 minutes for LNF and 89 ± 25 minutes for ONF (P < .001). Median LOS was 7.0 days (range, 3-57 days) and 7.5 days (range, 2-20 days) after LNF and ONF, respectively (P = .74). Postoperative complications occurred in 48 patients, 24 in both groups. Twenty-four patients (LNF: n = 12, ONF: n = 11) were readmitted to hospital because of complications occurring after discharge. CONCLUSIONS This study failed to show that LNF is superior to ONF when surgery duration, LOS, and complications occurring during the first postoperative month were compared. Apart from surgery duration, the results were surprisingly similar.
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24
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Goessler A. Gastroesophageal reflux in children – news, trends and standards. Eur Surg 2012. [DOI: 10.1007/s10353-012-0104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dingemann J, Kuebler JF, Ure BM. Laparoscopic and computer-assisted surgery in children. Scand J Surg 2012; 100:236-42. [PMID: 22182844 DOI: 10.1177/145749691110000402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Dingemann
- Centre of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
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Muensterer OJ, Keijzer R. Single-incision pediatric endosurgery-assisted ileocecectomy for resection of a NEC stricture. Pediatr Surg Int 2011; 27:1351-3. [PMID: 21461885 DOI: 10.1007/s00383-011-2884-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2011] [Indexed: 02/03/2023]
Abstract
A single-incision pediatric endosurgery (SIPES) has not been typically used for operations in premature infants yet. We report a case of a 3-month-old 25-week premature infant who underwent SIPES-assisted ileocecal resection for a stricture after medically treated necrotizing enterocolitis. The patient recovered uneventfully, and was discharged on full feeds 15 postoperatively with virtually no appreciable scar. SIPES is a reasonable alternative for NEC stricture resection in premature infants. Prematurity should not be considered a contraindication to single-incision endosurgery.
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Affiliation(s)
- Oliver J Muensterer
- Division of Pediatric Surgery, Weill Cornell Medical College, 525 East 68th Street, Box 209, New York, NY 10021, USA.
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Abstract
The advent of minimally invasive surgical techniques in the neonate has been delayed due to the limited working space and the unique physiology of the newborn. In the last decade, with the introduction of new instruments and techniques, many of the initial problems have been solved making minimally invasive surgery feasible for a variety of indications in the neonate and a favored approach in specialized centers around the world. Although an increasing number of reports document the feasibility of this exciting technique, data demonstrating its benefit compared to conventional surgery is limited. This review focuses on recent developments in minimally invasive surgery in neonates and the evidence for its use.
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