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Published on: August 11, 2023
Postoperative Small Bowel Obstruction Following Laparoscopic or Open Fundoplication in Children: A Retrospective
Michimasa Fujiogi1,2, Nobuaki Michihata3, Hiroki Matsui2
1Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Insights
Laparoscopic fundoplication (LF) significantly reduces the risk of postoperative small bowel obstruction (SBO) in children compared to open fundoplication (OF). This finding suggests a safer surgical approach for pediatric patients undergoing this common procedure.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes
Background:
- Postoperative small bowel obstruction (SBO) is a serious complication impacting children's quality of life.
- While laparoscopic surgery is known to reduce SBO in adults, evidence for its benefit in pediatric patients is limited.
- Fundoplication is a frequent abdominal procedure in pediatric surgery.
Purpose of the Study:
- To compare the incidence of SBO after laparoscopic fundoplication (LF) versus open fundoplication (OF) in children.
- To evaluate the long-term impact of surgical approach on SBO development in pediatric patients.
Main Methods:
- Retrospective analysis of a national inpatient database in Japan (July 2010-March 2016).
- Inclusion of pediatric patients (0-18 years) undergoing LF or OF.
- Propensity score adjustment to compare SBO occurrence between LF and OF groups.
Main Results:
- 1838 patients were analyzed: 1362 in the LF group and 476 in the OF group.
- SBO occurred in 1.4% of LF patients and 2.7% of OF patients (P=0.11).
- Propensity score-adjusted analysis revealed significantly lower SBO incidence in the LF group (HR, 0.36; P=0.01).
Conclusions:
- Laparoscopic fundoplication is associated with a significantly reduced risk of SBO in children compared to open fundoplication.
- This study provides evidence supporting the use of minimally invasive surgery for fundoplication in pediatric populations to mitigate SBO risk.
Background:
Postoperative small bowel obstruction (SBO) is one of the most serious adverse events resulting in deteriorated quality of life in children. Numerous studies have shown that laparoscopic surgery significantly reduces the occurrence of SBO compared with open surgery in adults. However, evidence of the advantages of laparoscopic surgery over open surgery in terms of reducing SBO is lacking in children. Fundoplication is a common abdominal procedure in children. This study was performed to compare the occurrence of SBO after laparoscopic fundoplication (LF) versus open fundoplication (OF).
Methods:
Using the Diagnosis Procedure Combination database, a national inpatient database in Japan, we retrospectively identified patients aged 0-18 years who underwent LF or OF from July 2010 to March 2016. Propensity score adjustment was used to compare the occurrence of SBO between the groups.
Results:
We identified 1838 eligible patients who underwent LF (n = 1362) or OF (n = 476). The median age at surgery was 4.0 and 1.5 years in the LF and OF group, respectively (P < 0.001). The median weight at admission was 11.4 and 7.5 kg, respectively (P < 0.001). Nineteen (1.4%) patients in the LF group and 13 (2.7%) in the OF group had at least one episode of SBO (P = 0.11, log-rank test). In the propensity score-adjusted Cox regression analysis, SBO was significantly less likely to occur in the LF than OF group (hazard ratio, 0.36; 95% confidence interval 0.16-0.82; P = 0.01).
Conclusions:
In this retrospective nationwide study, LF was significantly associated with a reduction in SBO compared with OF in children.
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