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Laparoscopic-modified Nissen fundoplication in children with familial dysautonomia
1Department of General and Pediatric Surgery, Hadassah University Hospital Mount Scopus, Jerusalem, Israel.
Insights
Laparoscopic antireflux surgery for familial dysautonomia (FD) in children is safe and effective. This minimally invasive approach offers a less complicated postoperative course and shorter hospital stays compared to open surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Genetics
Background:
- Familial dysautonomia (FD) often necessitates antireflux operations and gastrostomy in children.
- Aspiration of gastric juice poses significant risks to lung health.
- Facilitating liquid feeding is crucial for managing FD patients.
Purpose of the Study:
- To compare the safety and effectiveness of laparoscopic antireflux procedures versus traditional open techniques in pediatric patients with FD.
- To evaluate postoperative outcomes, complications, and hospitalization duration.
Main Methods:
- Retrospective review of pediatric patients with FD who underwent antireflux procedures between 1978 and 1996.
- Comparison of outcomes between 13 patients who had laparoscopic surgery and those who had traditional laparotomy.
- Data analysis focused on postoperative complications, ventilation needs, and hospital stay duration.
Main Results:
- Laparoscopic surgery resulted in a less complicated postoperative course with no need for mechanical ventilation or respiratory complications.
- The mean hospitalization period was significantly shorter for laparoscopic cases (7.9 days) compared to open surgery (13.2 days).
- No complications were attributed to laparoscopy, and the antireflux procedure was effective in all patients (short-term follow-up).
Conclusions:
- Laparoscopic antireflux procedures, including modified Nissen fundoplication, gastrostomy, and appendectomy, are feasible and safe for treating FD in children.
- The laparoscopic approach appears to have fewer complications than laparotomy.
- This technique may reduce the need for postoperative mechanical ventilation and shorten hospital stays.
Abstract:
Children with familial dysautonomia (FD) often require an antireflux operation and gastrostomy to prevent the detrimental effects of aspirated gastric juice on the lungs and to facilitate liquid feeding. The aim of this study was to examine whether a laparoscopic procedure in such patients is as safe and effective as the traditional open technique. The data for all pediatric patients who underwent a laparoscopic antireflux procedure for familial dysautonomia were reviewed and compared with those the last pediatric patients with FD who were operated upon using the open technique, before the introduction of the laparoscopic procedure. Of the 61 children who underwent an antireflux procedure for FD (1978-1996), 13 were operated on laparoscopically. The authors found that the postoperative course of these patients was less complicated than that of patients who had the traditional laparotomy procedure. There was no need for mechanical ventilation during the postoperative course, and there were no respiratory complications. The mean hospitalization period was significantly shorter (7.9 days v 13.2 days). There were no complications attributable to laparoscopy, and the antireflux procedure has been effective in all patients (short-term follow-up). The authors conclude that laparoscopic procedures that include a modified Nissen fundoplication, gastrostomy, and appendectomy are feasible and as safe as conventional surgery for the treatment of FD in children. It appears that this approach has fewer complications than laparotomy, might reduce the need for postoperative mechanical ventilation, and is associated with a shorter postoperative stay.
