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Published on: August 11, 2023
Laparoscopic fundoplication in children: anaesthetic experience of 51 cases
1Department of Anaesthesia, Royal Hospital for Sick Children, Sciennes Road,Edinburgh EH9 1LF, UK.
Insights
Laparoscopic fundoplication in children is a safe procedure with minimal analgesic needs and no requirement for high-dependency care post-surgery. This approach offers a well-tolerated surgical option for pediatric patients.
Area of Science:
- Pediatric Surgery
- Anesthesiology
Background:
- Laparoscopic fundoplication is a common surgical procedure for gastroesophageal reflux disease in children.
- Effective anesthetic management is crucial for successful outcomes in pediatric laparoscopic surgery.
Purpose of the Study:
- To evaluate the anesthetic management and patient outcomes of laparoscopic fundoplication in a pediatric cohort.
- To assess the feasibility and safety of managing these patients on a standard surgical ward postoperatively.
Main Methods:
- Retrospective review of case records for 50 pediatric patients undergoing laparoscopic fundoplication.
- Analysis of anesthetic parameters, intraoperative events, and postoperative recovery data.
Main Results:
- The median age of patients was 6 years, with a median anesthesia duration of 120 minutes.
- Hemodynamic changes were transient, and median increase in PECO2 was 1.0 kPa.
- 89% of patients required oral or rectal analgesics, with minimal analgesic needs post-discharge.
Conclusions:
- Laparoscopic fundoplication in children is well-tolerated under general anesthesia.
- Routine postoperative high-dependency care is not necessary for these patients.
- Pediatric laparoscopic fundoplication is associated with minimal analgesic requirements and short hospital stays.
Abstract:
We report the anaesthetic management and outcomes of our first 51 laparoscopic fundoplications. Case records of the 50 patients (one redo), median age 6 years (5 months to 20 years), were reviewed. Median duration of anaesthesia was 120 (60-300) min. During the procedure, the heart rate and blood pressure increased by more than 20% over baseline in 18% and 12% cases, respectively. Median increase in PECO2 was 1.0 (0.3-2.3) kPa [7.6 (2.3-18) mmHg]. After surgery, all but one of the patients were managed on a normal surgical ward. Postoperative analgesia requirement was oral or rectal analgesics in 89% of patients and ceased within 48 h of surgery in 95% patients. Median time to discharge home from day of operation was 2 (1-9) days. We conclude that laparoscopic fundoplication in children is well tolerated, there is no requirement for routine postoperative high dependency care and analgesic requirements are minimal.
