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Mangray H, Madziba SS, Ngobese A, Govender Y, Clarke DL. Implementation of Laparoscopic Nissen Fundoplications in a Developing South African Pediatric Surgical Service. J Indian Assoc Pediatr Surg 2024; 29:261-265. [PMID: 38912030 PMCID: PMC11192267 DOI: 10.4103/jiaps.jiaps_251_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Pediatric laparoscopic Nissen fundoplication (LNF) has become the standard approach at many centers. We developed a minimal access surgery (MAS) training curriculum to enhance the delivery of MAS for pediatric patients in a resource-limited setting. We reviewed our 10-year experience in implementing and performing LNF at our institution. Methods We described the challenges of implementing MAS training for LNF and how we addressed them. Beneficial technical considerations were described. A retrospective review was performed on all pediatric LNFs performed. Results We performed 268 LNFs. Specialists or trainees under supervision performed all LNFs. The trainee group performed 43 LNFs (16%). The median operative time for the specialists was 94 min (interquartile range [IQR] 50), and the trainee group was 140 min (IQR 62.5). The median number of cases performed until we improved operative time amongst the trainees was nine (IQR 3). There were seven repeat LNFs, and 11 cases were converted to open. The overall complication rate was 8.9%. A reduction in complications among specialists occurred over the years. The 30-day mortality post-LNF was 0.7%. Conclusion LNF can be successfully introduced at a tertiary training centre in South Africa with good outcomes. A comprehensive quality improvement program, including MAS training, supported this.
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Affiliation(s)
- Hansraj Mangray
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Sanele Stanley Madziba
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Amanda Ngobese
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Yashlin Govender
- Department of Paediatric Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
| | - Damian L. Clarke
- Department of Surgery, University of Kwazulu Natal, Greys Hospital, Pietermaritzburg, South Africa
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Briggs KB, Svetanoff WJ, Fraser JA, Aguayo P, Fraser JD, HolcombIII GW, St Peter SD. Fundoplication without esophagocrural sutures: Long-term follow-up of a randomized clinical trial. J Pediatr Surg 2022; 57:1499-1503. [PMID: 34980467 DOI: 10.1016/j.jpedsurg.2021.12.006] [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: 05/24/2021] [Revised: 10/14/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We previously conducted a randomized trial that showed a lack of need for esophagocrural (EC) sutures during fundoplication when no esophageal dissection was performed. There was no difference in wrap herniation or other complications in the group without EC sutures at a median 1.5 years of follow-up. In this follow-up study, we aim to evaluate long-term symptom control and complication profiles in these patients. METHODS 106 patients were randomized and participated in the original trial. We were primarily concerned with identification of late complications and persistence of symptoms. Presently, we conducted a retrospective chart review and a telephone follow-up survey at a minimum of 6.5 years after fundoplication. RESULTS 100 patients were alive at late follow-up and 70% of caregivers responded to the telephone survey. 53% of patients were male; 76% were Caucasian. Of these children, 39 (56%) received four EC sutures, while 31 (44%) did not. Follow-up was conducted at a median of 8.7 years [IQR 8.2,9.7] post-fundoplication. Late wrap herniation was not demonstrated radiographically on chart review or caregiver report in either group. The rate of residual reflux symptoms, post-operative hospitalizations for pneumonia, failure to thrive (FTT), and brief resolved unexplained event (BRUE) were also similar between groups. CONCLUSION Long-term follow-up in children who underwent fundoplication without esophagocrural sutures demonstrates no difference in symptom management or subsequent hospitalizations at a minimum of 6.5-year follow-up. LEVEL OF EVIDENCE II (follow-up of a randomized controlled trial).
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Affiliation(s)
- Kayla B Briggs
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - James A Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - George W HolcombIII
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States.
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Is There a Role for Elective Early Upper Gastrointestinal Contrast Study in Neurologically Impaired Children following Laparoscopic Nissen Fundoplication? CHILDREN-BASEL 2021; 8:children8090813. [PMID: 34572245 PMCID: PMC8472647 DOI: 10.3390/children8090813] [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: 08/12/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear. We aimed to evaluate the role of scheduled UGI contrast studies to identify early postoperative complications following laparoscopic Nissen fundoplication in NI children. Data for laparoscopic Nissen fundoplications performed in NI children between January 2004 and June 2021 were reviewed. A total of 103 patients were included, with 60 of these being boys. Mean age at initial operation was 6.51 (0.11-18.41) years. Mean body weight was 16.22 (3.3-62.5) kg. Mean duration of follow up was 4.15 (0.01-16.65 years) years. Thirteen redo fundoplications (12.5%) were performed during the follow up period; eleven had one redo and two had 2 redos. Elective postoperative UGI contrast studies were performed in 94 patients (91%). Early postoperative UGI contrast studies were able to identify only one complication: an intrathoracal wrap herniation on postoperative day five, necessitating a reoperation on day six. The use of early UGI contrast imaging following pediatric laparoscopic Nissen fundoplication is not necessary as it does not identify a significant number of acute postoperative complications requiring re-intervention.
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Minimal esophagus dissection without approximating the hiatus in laparoscopic fundoplication in pediatric population. North Clin Istanb 2021; 8:222-225. [PMID: 34222801 PMCID: PMC8240242 DOI: 10.14744/nci.2020.10693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/07/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE: An important part of laparoscopic Nissen’s fundoplication (LNF) is a proper wrap, which may only be possible with proper dissection of esophagus and hiatus. However, too much dissection of esophagus and hiatus to gain sufficient length of esophagus increases morbidity. The aim of this study is to analyze the effect of minimal esophagus dissection in LNF on recurrence and post-operative hiatal hernia. METHODS: The present study includes the children (0–18 years) who underwent LNF with minimal esophagus dissection and without hiatal closure between 2008 and 2016. The charts of the patients analyzed retrospectively and evaluated in terms of recurrence and post-operative hiatal hernia. RESULTS: There were 143 children. Mean age was 4.5±4.6 year (20 days–17 years). About 54% of the children (n=78) were neurologically impaired. There were two temporary intestinal obstructions which did not require surgery, one esophageal tightness which resolved with one dilatation session and one recurrence with hiatal hernia which required reoperation. CONCLUSION: Minimal esophagus dissection without hiatal closure in LNF avoids dysphagia with no increase in the rate of recurrence and complications.
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Svetanoff WJ, Dekonenko C, Briggs KB, Fraser J, Oyetunji TA, St. Peter SD. Are Posterior Crural Stitches Necessary in Pediatric Laparoscopic Fundoplication? J Laparoendosc Adv Surg Tech A 2020; 30:1272-1276. [DOI: 10.1089/lap.2020.0646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Charlene Dekonenko
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
- Department of General Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kayla B. Briggs
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - James Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Tolulope A. Oyetunji
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
- Univeristy of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Shawn D. St. Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
- Univeristy of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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Holcomb GW, St Peter SD. Error traps and safety steps when performing a laparoscopic Nissen fundoplication. Semin Pediatr Surg 2019; 28:160-163. [PMID: 31171151 DOI: 10.1053/j.sempedsurg.2019.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Quality and safety have come to the forefront of the current healthcare environment over the past 10 years. Although all surgeons feel they perform safe operations with quality outcomes, these variables are being increasingly measured in today's healthcare world. The purpose of this article is to describe our thoughts about the error traps and safety steps when performing a laparoscopic Nissen fundoplication. Hopefully, adherence to these technical points will help prevent the need for a second operative procedure due to transmigration of the fundoplication wrap or the need for esophageal dilation postoperatively.
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Affiliation(s)
- George W Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
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Miyano G, Yamoto M, Miyake H, Morita K, Kaneshiro M, Nouso H, Koyama M, Okawada M, Doi T, Koga H, Lane GJ, Fukumoto K, Yamataka A, Urushihara N. A Comparison of Laparoscopic Redo Fundoplications for Failed Toupet and Nissen Fundoplications in Children. J Indian Assoc Pediatr Surg 2019; 24:100-103. [PMID: 31105394 PMCID: PMC6417062 DOI: 10.4103/jiaps.jiaps_228_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: We compared laparoscopic redo fundoplications performed for failed laparoscopic Toupet fundoplication (LTF) and failed laparoscopic Nissen fundoplications (LNFs). Methods: Redo LTF (R-LTF; n = 4) and redo LNF (R-LNF; n = 6) performed between 2007 and 2014 were assessed retrospectively for severity of intraperitoneal adhesions on a scale of 0–3, identification/preservation of the anterior/posterior/hepatic branches of the vagus nerve (VN), complications, and outcome. Results: Redos were performed after a mean of 34 months in R-LTF and 32 months in R-LNF (P = ns) indicated for sliding hernia (n = 3; 2 with partial wrap dehiscence) and partial wrap dehiscence (n = 1) in R-LTF and sliding hernia (n = 6; 4 with partial wrap dehiscence) in R-LNF. The mean adhesion severity score was 1.5 in R-LTF and 2.5 in R-LNF (P < 0.05). The mean number of VN branches identified/preserved was 2.0 in R-LTF and 0.8 in R-LNF (P < 0.05). Mean operative times and mean blood loss were similar. Intraoperative complications were accidental local trauma (n = 1 in R-LTF and n = 3 in R-LNF, one requiring conversion to open repair) (P = ns). Gastric outlet obstruction developed in two R-LNF cases; both were managed conservatively. There have been no further recurrences to date. Conclusion: Although our series is small, adhesions were less, and identification/preservation of VN was easier during R-LTF.
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Affiliation(s)
- Go Miyano
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.,Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keiichi Morita
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masakatsu Kaneshiro
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroshi Nouso
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Mariko Koyama
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Manabu Okawada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Doi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- 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
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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