Identifying Responsible Factors for Poor Surgical Visibility in Pediatric Laparoscopic Fundoplication: A...

Laparoscopic fundoplication is commonly performed in patients with neurological impairment. However, these patients often have spinal deformities that can complicate achieving a clear surgical view. This study aimed to identify factors associated with poor visibility in pediatric laparoscopic fundoplication. Operative videos, medical records, and radiographs of patients who underwent laparoscopic fundoplication between 2015 and 2023 were retrospectively reviewed. The videos were reviewed by two pediatric surgeons and classified into good or poor visibility groups. Age, sex, height, weight, history of abdominal surgery, lordosis, operative time, blood loss, and intraoperative complications were compared between the two groups. Lordosis was evaluated using the sagittal view of computed tomography images, and the anterior vertebral depth and abdominal thickness were measured to calculate the ratio. Forty-one patients were included in this study. Based on the video review, the patients were classified into good (20 patients) and poor (21 patients) visibility groups. The median age, height, and weight were 6 years, 110 cm, and 16.1 kg, respectively. In the poor visibility group, 23.8% of patients had a history of abdominal surgery (P = .048). Additionally, the anterior vertebral depth to abdominal thickness ratios at the first and third lumbar vertebrae were significantly lower in the poor visibility group (P = .016 and P = .0018, respectively). There were no significant differences in the operative time, blood loss, or intraoperative complications between the two groups. Lordosis and a history of abdominal surgery may be risk factors for poor visibility in pediatric laparoscopic fundoplication.