小児における既存胃瘻造設術例でのニッセン الخلفية術：課題とコツ

Patients with an in-situ gastrostomy tube(G-tube) often require laparoscopic fundoplication (LF) for refractory gastro-oesophageal reflux disease. We evaluated the feasibility and outcomes of LF, identifying the need for gastrostomy detachment.

All LF performed between 2014 and 2024 by a single surgeon in a tertiary paediatric centre were retrospectively analysed. Clinical data, operative technical aspects and outcomes were analysed.

Of 170 LF,33 children had a G-tube. In 28 cases (85%, Group A), LF was completed without detaching the gastrostomy (median operating time 75 min). Five patients (15%, Group B) required detachment of the stoma due to severe scoliosis, giant hiatus hernia or short intra-abdominal oesophagus (median 100 min). There were no early postoperative complications in Group A, but five fundoplicationsfailed, requiring redo LF (twice in one patient). These six redo procedures were completed laparoscopically without detaching the gastrostomy. In Group B, one converted LF case required redo surgery for milk peritonitis secondary to dehiscence of the refashioned gastrostomy.

LF with an in-situ G-tube is safe and feasible with minimal risks. Patients with giant hiatus hernia, severe scoliosis or short intra-abdominal oesophagus are challenging, requiring tailored ports positioning to avoid detaching the pre-existing gastrostomy and its associated risks.