Evaluating the relevant factors affecting the perioperative outcomes of laparoscopic fundoplication in 100 neurologically impaired patients: a multicenter retrospective joint study

Postural features (e.g. scoliosis) make laparoscopic fundoplication more difficult in neurologically impaired patients (NIPs) than in non-NIPs [please check this carefully]. We therefore clarified the relevant factors associated with perioperative outcomes of NIPs.

NIPs who underwent laparoscopic Nissen fundoplication were enrolled. We classified the patients according to age into < 18- and ≥ 18-year-old groups and evaluated the factors associated with perioperative outcomes. The endpoints were patient characteristics, acid-reflux index, operative time, blood loss, postoperative outcomes, and Endoscopic Surgical Skill Qualification System (ESSQS) certification.

One hundred and one patients underwent laparoscopic fundoplication. Blood loss and operative time were significantly higher in the ≥ 18-year-old group than in the < 18-year-old group. A multivariate regression analysis revealed that no factors were significantly associated with blood loss. However, a significant association was observed between the procedure performed by the ESSQS-certified pediatric surgeon and the operative time. In terms of postoperative outcomes, the length of hospital stay after operations performed or supervised by ESSQS-certified pediatric surgeons was significantly shorter than that after operations performed by pediatric surgeons without ESSQS certification.

The involvement of pediatric surgeons with ESSQS certification was significantly associated with perioperative outcomes in NIPs during laparoscopic fundoplication, whereas physical characteristics and GER were not.

Level III, case-control study.