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Laparoscopic fundoplication in children with previous abdominal surgery
D C Liu1, G J Flattmann, M T Karam
1Children's Hospital of New Orleans, LA 70118, USA.
Insights
Laparoscopic Nissen fundoplication is safe and effective in children with prior abdominal surgeries, including gastrostomy tubes or VP shunts. This antireflux procedure shows excellent outcomes with minimal complications in this patient group.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastroesophageal reflux disease (GERD) is common in children, often necessitating antireflux surgery.
- A significant subset of these children have undergone prior abdominal surgeries, such as gastrostomy tube placement or ventriculoperitoneal (VP) shunts.
- The impact of previous abdominal surgeries on the outcomes of antireflux procedures is a critical consideration.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic Nissen fundoplication (LNF) in children with a history of abdominal surgery.
- To assess surgical outcomes, including complication rates and the functionality of pre-existing devices (gastrostomies, VP shunts).
Main Methods:
- A retrospective review of 82 consecutive LNF procedures performed between January 1996 and September 1998.
- Patients were stratified based on previous abdominal surgery: gastrostomy tube (n=17) or VP shunt (n=11).
- LNF was performed using a standard 5-port technique, with modifications such as not dividing short gastric vessels (Rosetti modification).
Main Results:
- 31.7% (26/82) of patients had prior abdominal surgery.
- LNF was successfully completed in 96.2% (25/26) of patients with previous abdominal surgery.
- No cases of recurrent reflux were reported, and all gastrostomies and VP shunts remained functional post-LNF, with minimal morbidity observed.
Conclusions:
- Laparoscopic Nissen fundoplication is a viable and safe surgical option for children with GERD and a history of abdominal surgery.
- The presence of gastrostomies or VP shunts does not preclude successful LNF with excellent functional outcomes.
- This approach offers a minimally invasive solution with low morbidity for a complex pediatric surgical population.
Background/Purpose:
In our institution, many children requiring antireflux surgery for gastroesophageal reflux have had previous abdominal surgery, usually gastrostomy tube or ventriculoperitoneal (VP) shunt placement. The authors review their laparoscopic Nissen fundoplication (LNF) experience in children with previous abdominal surgery assessing surgical outcome.
Methods:
A total of 82 consecutive LNFs performed at our institution between January 1996 and September 1998 were reviewed. Follow-up ranged from 1 month to 32 months (average, 8.9 months). LNF was performed without dividing short gastric vessels (Rosetti modification) through a standard 5-port technique.
Results:
A total of 26 of 82 patients (31.7%) had previous abdominal surgery and were divided into 2 groups: gastrostomy (n = 17) and VP shunt (n = 11) with 2 crossovers. A total of 14 of 17 (82.3%) in the gastrostomy group had percutaneous endoscopic gastrostomy (PEG) placement versus 3 of 17 (17.6%) by open technique (open). Four patients in the VP group had multiple surgeries (range, 1 to 10, average, 2.3). LNF was completed in 25 of 26 (96.2%). One operation was converted to an open procedure because of severe adhesions. In 13 of 17 (76.5%) the previous gastrostomy was not taken down. In 4 of 17 (23.5%), the gastrostomy was taken down to complete the procedure: 2 of 3 (66.7%) of the open group versus 2 of 14 (14.3%) of the PEG group. All 11 (100%) of the VP group had successful LNF. Two of 11 (18.2%) had shunt dysfunction at 2 months (shunt infection) and 4 months (clogged distal shunt), respectively. There have been no cases of recurrent reflux, and all gastrostomies and VP shunts were functional at the time of this report.
Conclusions:
Previous abdominal surgery is common in children with gastroesophageal reflux disease requiring an antireflux procedure. The authors conclude from these preliminary results that laparoscopic Nissen fundoplication can be performed safely with minimal morbidity and excellent functional results in children with gastrostomies or ventriculoperitoneal shunts.