Laparoscopic Nissen Fundoplication in Children with Neurological Impairment versus Neurologically Normal Children

Yohan Joo; Ju Yeon Lee; Jung Hyun Choi; Jung-Man Namgung; Seong-Chul Kim; Dae Yeon Kim

doi:10.13029/jkaps.2016.22.2.49

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Joo, Lee, Choi, Namgung, Kim, and Kim: Laparoscopic Nissen Fundoplication in Children with Neurological Impairment versus Neurologically Normal Children

Original Article

Journal of the Korean Association of Pediatric Surgeons 2016; 22(2): 49-53.

Published online: 22 December 2016

DOI: https://doi.org/10.13029/jkaps.2016.22.2.49

Laparoscopic Nissen Fundoplication in Children with Neurological Impairment versus Neurologically Normal Children

Yohan Joo^1,², Ju Yeon Lee^1,², Jung Hyun Choi^1,², Jung-Man Namgung^1,², Seong-Chul Kim^1,², Dae Yeon Kim^1,²

¹Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Pediatric Surgery, Asan Medical Center Children's Hospital, Seoul, Korea.

Correspondence: Dae Yeon Kim, Department of Pediatric Surgery, Asan Medical Center Children's Hospital, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3961, Fax: +82-2-3010-6863, kimdy@amc.seoul.kr

Received 19 August 2016 Revised 22 October 2016 Accepted 24 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to assess the long-term clinical outcome of laparoscopic Nissen fundoplication (LNF) in children according to their neurologic status.

Methods

The study retrospectively analyzed the data of 82 children (62 neurologically impaired and 20 neurologically normal children with primary gastroesophageal reflux disease) who had undergone LNF between 2003 and 2012. The main outcome measures were the occurrence of recurrence that required reoperation and post-procedure complications such as infections, pneumonia, and gastrointestinal complications including ileus, dysphagia, and delayed gastric emptying.

Results

The median age at the time of the LNF was 25 months (range, 1-192 months), and the median of body weight was 10.0 kg (range, 2.8-37.0 kg). The average weight gain was 1.55±1.68 kg at 6 months, 3.32±2.30 kg at 1 year, and 5.63±4.22 kg at 2 years after surgery. Six (9.7%) of the 62 neurologically impaired patients and two (10.0%) of neurologically normal lost their body weight or had no weight changes. Eight (12.9%) of the 62 neurologically impaired children had required redo surgery because of gastroesophageal reflux disease recurrences, while 2 (10.0%) of the 20 neurologically normal children had experienced recurrences. In the neurologically impaired children, the postoperative complications included pneumonia (n=1), wound infection (n=1), urinary tract infection (n=1), dysphagia (n=1), delayed gastric emptying (n=1), and ileus (n=2). All of these complications were not found in the neurologically normal group, except for only one case of infectious colitis. However, there was no statistically significant difference between the two groups in postoperative complications.

Conclusion

The outcomes of laparoscopic fundoplication were similar in the neurologically impaired children and in the neurologically normal children.

Keywords: Gastroesophageal reflux, Laparoscopy, Fundoplication, Neurologic deficit

Figures and Tables

Table 1

Causes of Neurologic Impairment

ICH, Intracranial hemorrhage.

Table 2

Clinical Characteristics of Patients

Values are presented as n only or median (range).

Table 3

Results of Operation

Values are presented as mean±SD, n (%), or median (range).

Table 4

Postoperative Complications

Values are presented as n (%).

Notes

^{CONFLICTS OF INTEREST} No potential conflict of interest relevant to this article was reported.

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