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Laparoscopic fundoplication and gastrostomy
1University of Alabama at Birmingham and The Children's Hospital of Alabama, Birmingham, AL 35233, USA.
Insights
Surgical treatment for pediatric gastroesophageal reflux, including fundoplication and gastrostomy, is effective with low recurrence rates. Laparoscopic approaches offer faster recovery and reduced complications compared to open procedures.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux is common in infants and children, often requiring surgical intervention.
- Fundoplication and gastrostomy are frequently performed procedures for managing severe reflux.
- Indications include chronic vomiting, failure to thrive, and pulmonary issues.
Purpose of the Study:
- To review surgical techniques, outcomes, and complications of fundoplication and gastrostomy.
- To evaluate the effectiveness of different fundoplication types (Nissen vs. Toupet).
- To compare laparoscopic and open surgical approaches.
Main Methods:
- Retrospective review of 389 pediatric patients undergoing fundoplication and/or gastrostomy over 5 years.
- Analysis of surgical techniques (Nissen, Toupet), patient feeding methods, operative times, and outcomes.
- Comparison of complication rates and recovery between laparoscopic and open procedures.
Main Results:
- Operative times decreased significantly with experience.
- Recurrent symptoms occurred in approximately 5% of patients.
- Laparoscopic fundoplication demonstrated outcomes equivalent to open surgery with reduced pain and faster recovery.
- Complications included transient dysphagia, and rare esophageal/gastric perforations.
Conclusions:
- Fundoplication and gastrostomy are effective surgical treatments for pediatric gastroesophageal reflux.
- Laparoscopic fundoplication offers significant advantages in terms of recovery and morbidity.
- Careful patient selection and surgical technique are crucial for optimal outcomes.
Abstract:
Fundoplication and gastrostomy are among the more common operative procedures performed in infants and children. This article reviews the techniques, results, and complications of the surgical treatment of gastroesophageal reflux in 389 consecutive pediatric patients over the last 5 years. Chronic unremitting vomiting, failure to thrive, and an array of pulmonary symptoms were the leading indications for fundoplication in these children. Children who eat by mouth were primarily treated by a Toupet fundoplication, whereas gastrostomy-fed children generally received a Nissen fundoplication. The time to perform fundoplication and gastrostomy in our patients averaged about 3 hours for the first 10 patients but required a little over 1 hour for the last 50 patients. Most patients were discharged by the second or third postoperative day. Recurrent symptoms have developed in about 5% of our patients. Five of the 201 children who received a Toupet fundoplication (partial wrap) have been converted to a complete wrap fundoplication. Two of the patients having a Nissen fundoplication have required reoperation for their symptoms. The primary complications were seven cases of transient dysphagia, one case of esophageal perforation, and one case of gastric perforation. Laparoscopic fundoplication seems to achieve results equivalent to open fundoplication and is associated with considerably less postoperative pain and morbidity as well as a more rapid recovery.