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Mattioli G, Cipriani MS, Barone G, Palo F, Arrigo S, Gandullia P, Avanzini S, Wong MCY. Pediatric nutritional surgery and its implications: results from a unicentric retrospective analysis. Pediatr Surg Int 2024; 40:116. [PMID: 38695977 PMCID: PMC11065931 DOI: 10.1007/s00383-024-05700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Existing guidelines provide weak recommendations on the surgical management of nutritional problems in children. The objective was to design a management pathway to address the best nutritional surgery (NS) procedure in a given patient. METHODS Retrospective analysis of children treated at our department from January 2015 to December 2019. The sample was divided into two groups according to presence or absence of neurological impairment (NI). Patients with NI (Group 1) were classified in three subgroups based on presenting symptoms: A-Dysphagia without gastroesophageal reflux (GER); B-GER with or without dysphagia; C-Symptoms associated with a delayed gastric emptying. RESULTS A total of 154 patients were included, 111 with NI. One-hundred-twenty-eight patients underwent only one procedure. Complications and mortality were superior in Group 1. In subgroup A, isolated gastrostomy was the first NS in all patients. In subgroup B most of patients were subjected to a Nissen fundoplication, while in 5 cases total esophagogastric dissociation (TEGD) was the first intervention. Considering the entire sample, 92.3% patients who underwent a TEGD did not require further procedures. CONCLUSION NS encompasses various procedures depending on presenting symptoms and neurological status. A management flowchart for these patients is proposed.
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Affiliation(s)
- Girolamo Mattioli
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Maria Stella Cipriani
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
- DINOGMI, University of Genoa, Genoa, Italy.
| | - Giulia Barone
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Federico Palo
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy Department, IRCCS, Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Stefano Avanzini
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Michela Cing Yu Wong
- Pediatric Surgery Department, IRCCS, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
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Steffens FC, Dahlheim M, Günther P, Mehrabi A, Vuille-Dit-Bille RN, Fetzner UK, Gerdes B, Frongia G. Impact of previous abdominal surgery on the outcome of fundoplication for medically refractory gastroesophageal reflux disease in children and young adults. Eur Surg 2022. [DOI: 10.1007/s10353-022-00775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Summary
Importance
Fundoplication (FP) is a well-established surgical treatment for gastroesophageal reflux disease (GERD) refractory to medical therapy in children and young adults. During FP, previous abdominal surgery (PAS) can impair the patient’s outcome by causing technical difficulties and increasing intra- and postoperative complication rates.
Objective
The aim of this study was to determine the impact of PAS on the short- and long-term outcome following FP for refractory GERD in a cohort of patients aged < 23 years.
Methods
We retrospectively analyzed 182 patients undergoing a total of 201 FP procedures performed at our university center for pediatric surgery from February 1999 to October 2019. Pre-, intra-, and postoperative variables were recorded and their impact on the rate of intraoperative complications and revision FP (reFP) was analyzed.
Results
A total of 201 FP procedures were performed on 182 patients: 119 (59.2%) as Thal-FP (180° anterior wrap) and 82 (40.8%) as Nissen-FP (360°circular wrap; 67.2% laparoscopic, 32.8% open, 8.9% conversion). The presence of PAS (95 cases, 47.3%) was associated with significantly longer operative times for FP (153.4 ± 53.7 vs.126.1 ± 56.4 min, p = 0.001) and significantly longer hospital stays (10.0 ± 7.0 vs. 7.0 ± 4.0 days, p < 0.001), while the rates of intraoperative surgical complications (1.1% vs. 1.9%, p = 1.000) and the rate re-FP in the long term (8.4% vs. 15.1%, p = 0.19) during a follow-up period of 53.4 ± 44.5 months were comparable to the group without PAS.
Conclusion
In cases of PAS in children and young adults, FP for refractory GERD might necessitate longer operative times and longer hospital stays but can be performed with surgery-related short- and long-term complication rates comparable to cases without PAS.
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Paraboschi I, Privitera L, Loukogeorgakis S, Giuliani S. Fluorescence-Guided Surgery (FGS) during a Laparoscopic Redo Nissen Fundoplication: The First Case in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:947. [PMID: 35883931 PMCID: PMC9325017 DOI: 10.3390/children9070947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
We present the first case of fluorescence-guided surgery (FGS) using indocyanine green (ICG) in a pediatric redo-Nissen fundoplication. The patient is a 17-year-old male with recurrent gastroesophageal symptoms who underwent primary antireflux surgery at 10 months of age. During the redo fundoplication, ICG was intravenously administered to help the visualization during the adhesiolysis between liver, stomach and right crus of the diaphragm and to spare small oesophageal vessels and the left gastric artery. In this case, FGS made the surgery easier than usual and likely reduced the risk of intra-operative complications. Therefore, we believe that this new technology should be regularly used in these types of complex intra-abdominal redo operations.
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Affiliation(s)
- Irene Paraboschi
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London WC1E 6BT, UK; (I.P.); (L.P.)
| | - Laura Privitera
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London WC1E 6BT, UK; (I.P.); (L.P.)
| | - Stavros Loukogeorgakis
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK;
| | - Stefano Giuliani
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London WC1E 6BT, UK; (I.P.); (L.P.)
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK;
- Cancer Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
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Short and long-term outcomes after pediatric redo fundoplication. J Pediatr Surg 2022; 57:765-769. [PMID: 34175122 DOI: 10.1016/j.jpedsurg.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/02/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Redo fundoplication (RF) is the most common surgical treatment for recurrent gastroesophageal reflux disease (GERD) in children, but outcomes after RF are rarely reported. The aim of this study was to assess short- and long-term outcomes after RF in childhood. METHODS The study is a follow-up study of patients undergoing RF from 2002 to 2020 at a teriary care center. Patients/parents were sent questionnaires recording symptoms of recurrent GERD, troublesome side-effects and satisfaction. Retrospective chart review was also performed. RESULTS 24/28 (86%) patients were included median 9 (1.6 months-17.7 years) years after RF. 16 (67%) had neurologic impairment. Indications for RF was recurrence of GERD (n = 18), discomfort or dysphagia from a herniated wrap (n = 5) and dysphagia from a slipped fundoplication (n = 1). Median operating time was 128 (95-250) min. Six (25%) patients experienced early major complications, of which two were gastrostomy related. Five (21%) patients experienced recurrence after RF. Three of these were symptom free at follow-up with medical treatment or re-RF. The most common symptom at follow-up was stomach pain (37%) and excessive flatulence (38%). 18/22 (95%) patients/parents would choose RF again, and 21/22 would recommend RF to someone in a similar situation. CONCLUSIONS RF is successful in treating recurrent GERD after primary fundoplication, and patient/parental satisfaction is high.
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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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Laxague F, Sadava EE, Herbella F, Schlottmann F. When should we use mesh in laparoscopic hiatal hernia repair? A systematic review. Dis Esophagus 2021; 34:6041174. [PMID: 33333552 DOI: 10.1093/dote/doaa125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/21/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
The use of mesh in laparoscopic hiatal hernia repair (LHHR) remains controversial. The aim of this systematic review was to determine the usefulness of mesh in patients with large hiatal hernia (HH), obesity, recurrent HH, and complicated HH. We performed a systematic review of the current literature regarding the outcomes of LHHR with mesh reinforcement. All articles between 2000 and 2020 describing LHHR with primary suturing, mesh reinforcement, or those comparing both techniques were included. Symptom improvement, quality of life (QoL) improvement, and recurrence rates were evaluated in patients with large HH, obesity, recurrent HH, and complicated HH. Reported outcomes of the use of mesh in patients with large HH had wide variability and heterogeneity. Morbidly obese patients with HH should undergo a weight-loss procedure. However, the benefits of HH repair with mesh are unclear in these patients. Mesh reinforcement during redo LHHR may be beneficial in terms of QoL improvement and hernia recurrence. There is scarce evidence supporting the use of mesh in patients undergoing LHHR for complicated HH. Current data are heterogeneous and have failed to find significant differences when comparing primary suturing with mesh reinforcement. Further research is needed to determine in which patients undergoing LHHR mesh placement would be beneficial.
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Affiliation(s)
- Francisco Laxague
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Emmanuel E Sadava
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
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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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Timerbulatov MV, Senderovich EI, Grishina EE, Gimaev EF, Kazakov NM. [Redo surgery after laparoscopic fundoplication]. Khirurgiia (Mosk) 2019:29-35. [PMID: 31626236 DOI: 10.17116/hirurgia201910129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze the results of redo surgeries after previous laparoscopic fundoplication. MATERIAL AND METHODS A retrospective analysis included 37 repeated anti-reflux surgeries. Control group consisted of 38 patients after the first anti-reflux surgery performed on the same clinical base. The causes of unsatisfactory results of the first operations were studied. Intraoperative data, immediate and long-term results of surgical treatment were compared in both groups. Quality of life in both groups was studied before surgery and in long-term period using GIQLI questionnaire. RESULTS The most common cause of recurrent reflux was a hernia recurrence combined with slipping or destruction of the fundoplication cuff. Dysphagia was usually a result of compression of the esophagus by tightly sutured diaphragmatic crura and recurrent paraesophageal hernia. The main group was characterized by significantly greater surgery time, hospital-stay, incidence of intraoperative and postoperative complications. However, a more significant improvement of quality of life (∆GIQLI) was observed in the main group due to the low QOL index before redo surgery. CONCLUSION Redo surgeries are effective and safe procedures. These operations significantly improve QOL in long-term period despite certain technical difficulties. Repeated surgeries for dysphagia accounted for 2%, for recurrent reflux - 6%. Persistent postoperative dysphagia is usually associated with diaphragm repair rather fundoplication cuff. Reflux recurrence is often caused by cuff slippage and recurrent hernia.
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Affiliation(s)
| | | | | | - E F Gimaev
- Ufa City Clinical Hospital #21, Ufa, Russia
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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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Tanaka Y, Tainaka T, Uchida H. Indications for total esophagogastric dissociation in children with gastroesophageal reflux disease. Surg Today 2018; 48:971-977. [PMID: 29435660 DOI: 10.1007/s00595-018-1636-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
Total esophagogastric dissociation (TED) is used to treat gastroesophageal reflux (GER) after failed fundoplication in neurologically impaired patients. It is now performed for some otherwise healthy patients with severe GER. In this procedure, the gastrointestinal tract is reconstructed in a non-physiological way with a Roux-en-Y esophagojejunal anastomosis and jejuno-jejunostomy. Although TED eliminates almost all GER, some patients experience late complications. In this review, we investigated the long-term outcomes after TED to determine the best indications. In total, 147 neurologically impaired patients and 28 neurologically normal patients were identified. The total rate of complications requiring re-operation was 17.2% in neurologically impaired patients and 32.1% in normal patients, both higher than the rates associated with fundoplication. Although most authors added pyloroplasty when there was a concern of gastric emptying, this sometimes caused bile reflux. Nutritional and metabolic complications, including dumping syndrome and chronic digestive malabsorption, were also reported to occur after TED. TED is an option for the treatment of neurologically impaired patients with recurrent GER after fundoplication or who are at a high risk of recurrence of GER with fundoplication. However, neurologically normal patients who have the ability to obtain nutrition orally should consider options other than TED, as postoperative complications are frequent.
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Affiliation(s)
- Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, 339-8551, Japan.
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Zhang P, Tian J, Jing L, Wang Q, Tian J, Lun L. Laparoscopic vs. open Nissen's fundoplication for gastro-oesophageal reflux disease in children: A meta-analysis. Int J Surg 2016; 34:10-16. [PMID: 27554458 DOI: 10.1016/j.ijsu.2016.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Available evidence showed inconsistent results between laparoscopic Nissen's fundoplication (LNF) and open Nissen's fundoplication (ONF) for children with gastro-oesophageal reflux disease (GERD), so this study aimed to evaluate the efficacy and safety between LNF and ONF. METHODS Systematic, comprehensive literature searches were conducted to include randomized controlled trials (RCTs) that compared LNF and ONF for GERD. Two reviewers independently selected studies, abstracted data and assessed the methodological quality and evidence level. Data was analyzed by Review Manager Version 5.0. Risk ratio (RR) was used for dichotomous outcomes, and mean difference (MD) was used for continuous scales. Heterogeneity was estimated with the I2 statistic, fixed-effect model was used if I2 <50%, and otherwise random-effects model was used. RESULTS Three RCTs (171 children) were included. There was not a statistical difference in mortality (RR 1.12, 95%CI 0.50 2.48), or postoperative complications (RR 0.87, 95%CI 0.61 1.25), readmission (RR 1.53, 95%CI 0.67 3.51), or hospital stay (MD 0.85, 95%CI -0.06 1.75) between LNF and ONF. But LNF was associated with more incidence of recurrence (RR 3.32, 95%CI 1.40 7.84), longer surgery duration (MD 76.33, 95%CI 69.37 83.28), but fewer retching (RR 0.11, 95%CI 0.02 0.58) than ONF. CONCLUSIONS LNF might be as effective and safe as ONF in the short and long term, but both were associated with high risk of recurrence and mortality, especially for those children with neurological impairment, before the age of 18 months and female gender. This required a comprehensive evaluation of children before surgery.
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Affiliation(s)
- Peng Zhang
- Department of Pediatric Surgery, Nanyang Central Hospital, Nanyang, Henan Province, 47300, China.
| | - Jing Tian
- Department of Neonatal Intensive Care Unit, Nanyang Central Hospital, Nanyang, Henan Province, 47300, China.
| | - Li Jing
- Zonglian College, Xi'an Jiaotong University, Xi'an, Shaanxi, 710033, China.
| | - Quan Wang
- Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Four Military Medical University, Xi'an, Shaanxi, 710033, China.
| | - Jinhui Tian
- Evidence Based Medicine Center, School of Basic Medical Science of Lanzhou University, Lanzhou, Gansu, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, 730000, China.
| | - Li Lun
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410000, China.
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