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Laparoscopic Nissen fundoplication in disabled infants and children
1Department of Paediatric Surgery, St James's University Hospital, Leeds, England.
Insights
Laparoscopic fundoplication is a successful surgical option for neurologically impaired children facing feeding difficulties and aspiration. This minimally invasive approach offers clinical improvement, though careful technique adaptation for pediatric patients is crucial.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Neurologically impaired infants and children often experience feeding difficulties, vomiting, and recurrent aspiration.
- Medical management frequently fails to resolve these complex issues, necessitating surgical intervention.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic fundoplication in neurologically impaired pediatric patients.
- To identify key considerations for adapting the surgical technique in this specific population.
Main Methods:
- A 16-month study involving 15 neurologically impaired children undergoing laparoscopic fundoplication.
- Surgical access was individualized based on patient size; combined procedures with gastrostomy were also performed.
- Postoperative care involved limited analgesia, early feeding, and monitoring for complications.
Main Results:
- Twelve of fifteen patients demonstrated clinical improvement following the procedure.
- Common postoperative issues included gas bloating; three children experienced diarrhea.
- Two patients required conversion to open surgery due to complications like hypercarbia or esophageal perforation.
Conclusions:
- Laparoscopic fundoplication can be a successful treatment for feeding difficulties and aspiration in neurologically impaired children.
- Tailoring the surgical technique for pediatric patients, especially those with disabilities, is essential for optimal outcomes.
- Further investigation into this technique is warranted.
Abstract:
During a 16-month period, 15 neurologically impaired infants and children for whom medical treatment failed underwent laparoscopic fundoplication. The indications for surgery included feeding difficulties, vomiting, and recurrent chest aspiration. The patients' weight range was 3.9 and 42 kg (6 weighed less than 12 kg). Access was modified according to each patient's size and shape. The average operating time was 2.2 hours (range, 1.4 to 3) for fundoplication and 3.1 hours (range, 2.3 to 4.1) for fundoplication with gastrostomy. Two patients had conversion to open surgery because of hypercarbia or perforated oesophagus. Use of postoperative analgesia was limited to the first 24 hours, and fluid intake and feeding were begun on days 1 and 2, respectively. Gas bloating was common postoperatively, and diarrhoea developed in three children. Twelve patients had clinical improvement, and a recurrent hiatus hernia developed in one. Laparoscopic fundoplication can be successful; however, awareness of the differences in technique for paediatric (disabled children in particular) and adult patients is essential. The technique deserves further investigation.