Journal List > J Korean Assoc Pediatr Surg > v.22(2) > 1071972

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

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.

Figures and Tables

Table 1

Causes of Neurologic Impairment

jkaps-22-49-i001

ICH, Intracranial hemorrhage.

Table 2

Clinical Characteristics of Patients

jkaps-22-49-i002

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

Table 3

Results of Operation

jkaps-22-49-i003

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

Table 4

Postoperative Complications

jkaps-22-49-i004

Values are presented as n (%).

Notes

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

References

1. Mattioli G, Esposito C, Lima M, Garzi A, Montinaro L, Cobellis G, et al. Italian multicenter survey on laparoscopic treatment of gastro-esophageal reflux disease in children. Surg Endosc. 2002; 16:1666–1668.
crossref
2. Martinez DA, Ginn-Pease ME, Caniano DA. Sequelae of antireflux surgery in profoundly disabled children. J Pediatr Surg. 1992; 27:267–271. discussion 271-3.
crossref
3. Flake AW, Shopene C, Ziegler MM. Anti-reflux gastrointestinal surgery in the neurologically handicapped child. Pediatr Surg Int. 1991; 6:92–94.
crossref
4. Pearl RH, Robie DK, Ein SH, Shandling B, Wesson DE, Superina R, et al. Complications of gastroesophageal antireflux surgery in neurologically impaired versus neurologically normal children. J Pediatr Surg. 1990; 25:1169–1173.
crossref
5. Esposito C, Van Der Zee DC, Settimi A, Doldo P, Staiano A, Bax NM. Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired children. Surg Endosc. 2003; 17:708–710.
6. Nam SH, Kim DY, Kim SC, Kim IK. Laparoscopic nissen fundoplication in children for treatment of gastroesophageal reflux disease. J Korean Assoc Pediatr Surg. 2007; 13:13–22.
crossref
7. Diaz DM, Gibbons TE, Heiss K, Wulkan ML, Ricketts RR, Gold BD. Antireflux surgery outcomes in pediatric gastroesophageal reflux disease. Am J Gastroenterol. 2005; 100:1844–1852.
crossref
8. Capito C, Leclair MD, Piloquet H, Plattner V, Heloury Y, Podevin G. Long-term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children. Surg Endosc. 2008; 22:875–880.
crossref
9. Kim ST, Lee CK, Kim HE, Seo JM, Lee SK. The eleven years’ experience with fundoplication in infants and children. J Korean Assoc Pediatr Surg. 2008; 14:27–36.
crossref
TOOLS
Similar articles