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No increase in gastroesophageal reflux after laparoscopic gastrostomy in children
Ingrid Plantin1, Einar Arnbjörnsson, Lars-Torsten Larsson
1Department of Paediatric Surgery, University Hospital, 221 85, Lund, Sweden.
Insights
Laparoscopic video-assisted gastrostomy in children with neurological disabilities did not worsen acid gastroesophageal reflux (GER). Postoperative reflux index (RI) showed a non-significant reduction, indicating the procedure is safe for managing GER.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Neurologically disabled children often require gastrostomy for nutritional support.
- Gastroesophageal reflux (GER) is a common comorbidity in this population.
- The impact of laparoscopic gastrostomy on GER requires evaluation.
Purpose of the Study:
- To assess the effect of laparoscopic video-assisted gastrostomy on acid gastroesophageal reflux (GER).
- To evaluate the safety and efficacy of this surgical technique in pediatric patients with GER.
Main Methods:
- Prospective uncontrolled study involving 23 neurologically disabled children.
- 24-hour pH monitoring performed preoperatively and 12 months postoperatively.
- Gastrostomy placed on the anterior stomach wall near the lesser curvature.
Main Results:
- The reflux index (RI) showed a non-significant reduction from 6.8% preoperatively to 3.7% postoperatively.
- No significant increase in acid reflux was observed after the procedure.
- Laparoscopic gastrostomy did not aggravate existing GER symptoms.
Conclusions:
- Laparoscopic video-assisted gastrostomy is a safe procedure for neurologically disabled children with GER.
- The technique does not worsen acid reflux, offering a viable option for nutritional support.
- Further research may explore long-term outcomes and optimal stoma placement.
Abstract:
The objective of the study was to assess the influence of a laparoscopic video-assisted gastrostomy on acid gastroesophageal reflux (GER). A prospective uncontrolled study included 23 neurologically disabled children, from 10 months to 15 years of age, all with severe nutritional problems and in need of a gastrostomy. They all had a history of clinical GER problems including vomiting, choking and chest infections. A 24-h pH monitoring was used for a quantitative assessment of GER the day before surgery and 12+/-3 months (7-22 months) postoperatively. The gastrostomy was placed on the anterior wall of the stomach near the lesser curvature. The main outcome measure was the comparison of the pre- and postoperative 24-h pH monitoring and the reflux index (RI), i.e. the percentage of time with pH below 4. The results showed a non-significant reduction of RI from 6.8+/-4.5 preoperatively to 3.7+/-2.0 postoperatively. We conclude that a gastrostomy using the video-assisted technique and placing the stoma on the anterior wall of the stomach close to the lesser curvature does not cause aggravation of acid reflux.
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