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Laparoscopic antireflux surgery in infants with single ventricle physiology: a review
Brian C H Gulack1, Obinna O Adibe
1Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Insights
Laparoscopic gastric surgery may be safe for infants with hypoplastic left heart syndrome (HLHS) during their staged reconstruction. Further research is needed to confirm safety and optimal outcomes for these complex pediatric patients.
Area of Science:
- Pediatric surgery
- Congenital heart disease
- Gastrointestinal surgery
Background:
- Laparoscopic fundoplication and gastrostomy tube placement are increasingly used in pediatric patients.
- Infants with congenital heart defects, particularly single ventricle physiology like hypoplastic left heart syndrome (HLHS), often require gastric surgery.
- Concerns exist regarding the safety of laparoscopic approaches in HLHS patients undergoing staged cardiac reconstruction.
Purpose of the Study:
- To review the staged reconstruction process in infants with HLHS.
- To address safety concerns of non-cardiac procedures during the interstage period for HLHS patients.
- To evaluate the current literature on laparoscopic gastric surgery outcomes in single ventricle physiology.
Main Methods:
- Literature review of staged cardiac reconstruction in HLHS.
- Analysis of safety considerations for interstage non-cardiac procedures.
- Synthesis of existing studies on laparoscopic gastric surgery in single ventricle patients.
Main Results:
- The review examines the specific challenges and considerations for laparoscopic gastric surgery in HLHS.
- Safety concerns related to interstage management and non-cardiac interventions are discussed.
- Current literature on outcomes of these procedures in single ventricle physiology is analyzed.
Conclusions:
- Laparoscopic gastric surgery may be a viable option for infants with HLHS during staged reconstruction.
- Careful consideration of the unique physiology and interstage management is crucial.
- Further research is warranted to establish definitive safety and efficacy.
Abstract:
Laparoscopic fundoplication and gastrostomy tube placement have grown in popularity within the pediatric population for treatment of gastroesophageal reflux disease and failure to thrive, respectively. One population that has an increased need for gastric surgery in infancy is patients with congenital heart defects, especially those with "single ventricle physiology." The most common defect included in this population is hypoplastic left heart syndrome (HLHS). Because of the abnormal physiology present in this condition, there are concerns with regard to the use of laparoscopic procedures for gastric surgery in patients treated with a three-staged reconstruction. We review the staged reconstruction of infants with HLHS, address safety concerns of interstage noncardiac procedures on this patient population, and review the current literature regarding outcomes of laparoscopic gastric surgery on patients with single ventricle physiology.