Abstract
Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear. We aimed to evaluate the role of scheduled UGI contrast studies to identify early postoperative complications following laparoscopic Nissen fundoplication in NI children. Data for laparoscopic Nissen fundoplications performed in NI children between January 2004 and June 2021 were reviewed. A total of 103 patients were included, with 60 of these being boys. Mean age at initial operation was 6.51 (0.11–18.41) years. Mean body weight was 16.22 (3.3–62.5) kg. Mean duration of follow up was 4.15 (0.01–16.65 years) years. Thirteen redo fundoplications (12.5%) were performed during the follow up period; eleven had one redo and two had 2 redos. Elective postoperative UGI contrast studies were performed in 94 patients (91%). Early postoperative UGI contrast studies were able to identify only one complication: an intrathoracal wrap herniation on postoperative day five, necessitating a reoperation on day six. The use of early UGI contrast imaging following pediatric laparoscopic Nissen fundoplication is not necessary as it does not identify a significant number of acute postoperative complications requiring re-intervention.
Highlights
Impaired children (NI) often experience feeding problems due to esophageal dysmotility, reduced lower esophageal pressure, increased intra-abdominal pressure, and delayed gastric emptying [1]
Children who underwent a laparoscopic Nissen fundoplication without gastrostomy were compared to those with a pre-existing or simultaneously performed gastrostomy during initial fundoplication to identify a gastrostomy as a possible factor associated with redo fundoplication in Neurologically impaired children (NI) children
In line with other centers, we predominantly focus on the patient’s clinical symptoms especially in neurologically impaired children to determine the need for fundoplication
Summary
Impaired children (NI) often experience feeding problems due to esophageal dysmotility, reduced lower esophageal pressure, increased intra-abdominal pressure, and delayed gastric emptying [1]. Several studies have demonstrated the high incidence of gastroesophageal reflux (GER) in NI children with clinical symptoms such as vomiting and regurgitation in 20–30% of this population [2]. Indications for anti-reflux surgery are symptoms or complications of gastroesophageal reflux disease (GERD) not sufficiently relieved with conservative treatment [3,4]. Nissen fundoplication has emerged as a feasible therapeutic option to treat refractory GERD in both neurological normal and NI children. Despite its common use in pediatric surgery and decades of performance, high rates of complications and recurrences after Nissen fundoplication in NI patients have been reported, even if these results are not homogenous [5,6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
