Laparoscopic fundoplication in neonates and young infants: Failure rate and need for redo at a high-volume center
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- 作者：Pablo Laje ; laje@email.chop.edu ; Thane A. Blinman ; Michael L. Nance ; William H. Peranteau
- 关键词：Laparoscopic fundoplication ; Redo fundoplication ; Infants ; Failure rate
- 刊名：Journal of Pediatric Surgery
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：52
- 期：2
- 页码：257-259
- 全文大小：179 K
- 卷排序：52
文摘
Present the outcomes of patients younger than 2 years who underwent laparoscopic fundoplication, highlighting the failure rate and need for redo fundoplication.MethodsRetrospective review of patients < 2 years who underwent laparoscopic fundoplication between January 2009 and December 2014.Main results458 infants younger than 2 years underwent laparoscopic fundoplication in the 6-year period (360 Nissen, 77 Toupet and 21 Thal fundoplications). Median age at surgery was 5 (1–23) months. Median follow-up was 3 (1–6) years. The conversion rate was 0.87% (4 of 458 cases). Patients did not undergo routine studies to assess the incidence of postoperative GER but were instead followed clinically. Failure of the fundoplication was determined when a patient was unable to gain weight and/or protect the airway while receiving gastric feedings because of GER. The failure rate in our experience was 2.6% (12 redo out of 458 cases [11/360 Nissen, 1/77 Toupet and 0/21 Thal]). All failed cases occurred because of migration of the fundoplication, confirmed preoperatively by a contrast study. Median time between the initial fundoplication and the redo was 13 (5–27) months. There were no failures within a contemporaneous group of 101 patients < 2 years who underwent open fundoplication.ConclusionThe need for a redo fundoplication after a laparoscopic fundoplication was an uncommon event in our experience (12 of 458 cases). Our results contrast with published studies that report higher failure rates. Case volume per surgeon may explain in part the dissimilar results among studies.Level of evidenceIII.