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Complications of laparoscopic antireflux surgery in childhood
C Esposito1, P Montupet, G Amici
1Division of Pediatric Surgery, Federico II University and Magna Praecia University of Catanzaro, Naples, Italy.
Insights
Laparoscopic fundoplication is an effective treatment for pediatric gastroesophageal reflux disease (GERD), with a low complication rate. Severe complications can be managed effectively using the same laparoscopic approach.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Gastroesophageal reflux disease (GERD) is a common condition in children.
- Laparoscopic surgery offers a minimally invasive treatment option for pediatric GERD.
- Assessing complications is crucial for evaluating surgical safety and efficacy.
Purpose of the Study:
- To evaluate the complications associated with laparoscopic treatment of GERD in pediatric patients.
- To determine the safety and effectiveness of laparoscopic fundoplication in children.
- To analyze intraoperative and postoperative complication rates and their management.
Main Methods:
- A retrospective review of 289 children treated for GERD using laparoscopic surgery between March 1992 and March 1998.
- Procedures included Nissen-Rossetti (51.3%) and Toupet (48.7%) techniques.
- Patient demographics included age (4 months–17 years) and weight (5–52 kg).
Main Results:
- Overall complication rate was 5.1% intraoperatively and 3.4% postoperatively.
- No deaths or anesthesiological complications occurred.
- Conversion to open surgery was required in 1.3% of cases; severe complications were effectively managed laparoscopically.
Conclusions:
- Laparoscopic fundoplication is a safe and adequate treatment for pediatric GERD.
- The procedure demonstrates a low rate of complications.
- Laparoscopic management is effective even for severe complications, supporting its use in pediatric GERD treatment.
Background:
The aim of this study was to assess the complications associated with the laparoscopic treatment of gastroesophageal reflux disease (GERD) in children.
Methods:
From March 1992 to March 1998, we used the laparoscopic approach to treat 289 children affected by gastroesophageal reflux disease. The patients' ages ranged between 4 months and 17 years (median, 4.3 years), and their body weight ranged between 5 and 52 kg. In 148 children (51.3%), we adopted a Nissen-Rossetti procedure and in 141 (48.7%) a Toupet technique.
Results:
The duration of surgery ranged between 40 and 180 min (median, 70). There were no deaths and no anesthesiological complications in our series. We recorded 15 (5.1%) intraoperative complications: six pleural perforations, four lesions of the posterior vagus nerve, two esophageal perforations, two gastric perforations, and one pericardiac perforation. Conversion to open surgery was necessary in only four cases (1.3%). We recorded 10 (3.4%) postoperative complications: one peritonitis due to an esophageal perforation not detected during the intervention that required a reoperation, five cases of herniation of the epiploon through a trocar orifice, three cases of dysphagia that disappeared spontaneously after a few months, and one case of delayed gastric emptying that subsequently required a pyloroplasty. We had six recurrences of GERD (2.1%). In two cases, a new fundoplication was performed using the laparoscopic approach; in the other four, the GERD was controlled with medical therapy.
Conclusion:
Our results show that laparoscopic fundoplication is an adequate treatment for children with GERD that has a low rate of complications. When severe complications do occur, they can be treated effectively via the laparoscopic approach.