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Laparoscopic antireflux surgery in neurologically impaired children
M Lima1, M Bertozzi, G Ruggeri
1Pediatric Surgery, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy. m.lima@med.unibo.it
Insights
Laparoscopic fundoplication is a safe and effective surgical option for neurologically impaired children with severe gastroesophageal reflux. This minimally invasive procedure offers significant clinical improvement with minimal drawbacks.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) significantly impacts the health and development of neurologically impaired children.
- Medical management often fails, necessitating surgical intervention for severe GER.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic fundoplication in neurologically impaired pediatric patients with refractory GER.
- To assess the outcomes and complications associated with this minimally invasive surgical approach.
Main Methods:
- A retrospective review of 48 laparoscopic fundoplications performed between May 1996 and April 2002 in 47 neurologically impaired children.
- Standard laparoscopic Nissen fundoplication technique with patient-specific modifications.
- Inclusion criteria: failure of medical therapy, persistent vomiting, recurrent infections, failure to thrive, and confirmed GER via barium swallow and pHmetry.
Main Results:
- 45 out of 47 patients (95.7%) experienced significant clinical improvement post-surgery.
- Two patients required conversion to open surgery due to complications (kyphoscoliosis, diaphragmatic perforation).
- One patient developed a paraesophageal hernia, and another experienced stenosis; both were managed postoperatively.
Conclusions:
- Laparoscopic fundoplication is a viable and advantageous surgical treatment for pediatric GER, particularly in neurologically impaired children.
- The procedure demonstrates high success rates and comparable outcomes to open surgery with fewer complications.
- Minimally invasive surgery should be strongly considered for pediatric patients suffering from severe gastroesophageal reflux.
Abstract:
From May 1996 to April 2002, 48 laparoscopic fundoplications were performed after failure of medical treatment in 47 neurologically impaired infants and children affected by gastroesophageal reflux. Indications for surgery included vomiting, recurrent upper airway infections, failure of medical therapy, feeding difficulties with failure to gain weight, and instrumental (barium swallow and pHmetry) diagnosis of gastroesophageal reflux. A standard approach was adopted, with minimal access modifications according to the patients' characteristics. In two patients, laparoscopic surgery had to be converted to open surgery because of severe kyphoscoliosis and accidental left emidiaphragm perforation. In another patient undergoing a laparoscopic Nissen fundoplication, a re-do laparoscopic operation was performed. Postoperative analgesia was administered during the first 12 h, and fluid intake and feeding were begun on days 1 and 2, respectively. All patients clinically improved except two; a paraesophageal hernia developed in one, and a stenosis developed in the other. We strongly believe that laparoscopic fundoplication can be successfully adopted in neurologically impaired children as well as in pediatric patients as a whole, with the same advantages and far fewer drawbacks than are expected in adults.
