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Laparoscopic proximal Roux-en-Y gastrojejunal diversion in children: preliminary experience from a single center
Girolamo Mattioli1, Piero Buffa, Paolo Gandullia
1Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
Insights
Laparoscopic Roux-en-Y gastrojejunal bypass with Nissen fundoplication effectively treats gastroesophageal reflux (GER) and gastric emptying disorders in neurologically impaired children. This surgical approach offers a safe and feasible solution for managing complex feeding issues in this vulnerable population.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastrointestinal Motility Disorders
Background:
- Neurologically impaired children (NIC) frequently experience recurrent gastroesophageal reflux (GER) post-fundoplication.
- Gastric emptying disorders in NIC often necessitate aggressive interventions beyond standard feeding tubes.
- Alternative surgical procedures like esophagogastric dissociation and gastric bypass exist, but their application in NIC with GER requires further investigation.
Purpose of the Study:
- To evaluate the preliminary experience of using laparoscopic Roux-en-Y gastrojejunal bypass combined with Nissen fundoplication and gastrostomy.
- To assess the efficacy of this combined procedure in treating and preventing GER in NIC with associated gastric emptying disorders.
Main Methods:
- Eight NIC with feeding problems and pulmonary complications underwent a surgical procedure.
- The surgical technique involved hiatoplasty, Nissen fundoplication, a 20-cm Roux-en-Y gastrojejunal anastomosis, jejuno-jejunal anastomosis, and gastrostomy.
- Postoperative feeding commenced on day 3, with outcomes assessed via upper gastrointestinal contrast studies and endoscopies.
Main Results:
- All patients tolerated postoperative feeding starting on day 3 without immediate complications.
- One patient required reoperation due to distal anastomosis obstruction caused by adhesions.
- Clinical outcomes were monitored through serial imaging and endoscopic evaluations.
Conclusions:
- Laparoscopic proximal Roux-en-Y gastrojejunal diversion, without gastric resection, is a safe and feasible surgical option for NIC.
- The procedure demonstrates potential in improving gastric emptying and reducing GER recurrence.
- Long-term efficacy and outcomes of this surgical approach require further evaluation.
Background:
Neurologically impaired children (NIC) have a high risk of recurrence of gastroesophageal reflux (GER) following fundoplication. A postpyloric feeding tube may be useful when gastric emptying disorders occur; however, dislocation and difficulty in feeding management often require more aggressive procedures. Total esophagogastric dissociation (Bianchi's TEGD) is an alternative to the classic fundoplication procedure, whereas laparoscopic gastric bypass is a frequently performed procedure in morbid obesity, improving gastric outlet.
Aim:
The aim of this paper is to present a preliminary experience on the laparoscopic Roux-en-Y gastrojejunal bypass, associated with Nissen fundoplication and gastrostomy, to treat and prevent GER in NIC with gastric emptying disorders.
Materials And Methods:
Eight neurologically impaired children underwent surgical treatment because of feeding problems and pulmonary complications. The procedure included: 1) hiatoplasty, 2) Nissen fundoplication, 3) 20-cm Roux-en-Y gastrojejunal anastomosis and jejuno-jejunal anastomosis, and 4) gastrostomy.
Results:
All cases were fed on postoperative day 3 without any intraoperative complications. One case developed an obstruction of the distal anastomosis due to adhesion and needed reoperation. Outcome was clinically evaluated with serial upper gastrointestinal contrast studies and endoscopies.
Conclusions:
Laparoscopic proximal Roux-en-Y gastrojejunal diversion, without gastric resection, is a safe, feasible procedure that improves gastric emptying and reduces the risk of GER recurrence. Yet, long-term results still have to be evaluated.
