Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired children

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• 作者：C. Esposito ; D. C. Van Der Zee ; A. Settimi ; P. Doldo ; A. Staiano and N. M. A. Bax
• 关键词：Gastroesophageal reflux ; Neurologically impaired children ; Laparoscopy
• 刊名：Surgical Endoscopy
• 出版年：2003
• 出版时间：May 2003
• 年：2003
• 卷：17
• 期：5
• 页码：708-710
• 全文大小：78 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Gynecology
  Gastroenterology
  Hepatology
  Proctology
  Abdominal Surgery
  
• 出版者：Springer New York
• ISSN：1432-2218

文摘

Background: The aim of this study was to investigate the feasibility and results of laparoscopic antireflux procedure in neurologically impaired children. Methods: Over a 5-yr period, 259 children affected by gastroesophageal reflux disease underwent laparoscopic antireflux procedure. Eighty of them (30.8%) were neurologically impaired. In 58 children we performed an anterior fundoplication according to Thal and in 22 patients a 360° fundoplication according to Nissen. Forty-eight children underwent an associated gastrostomy placement at the same time as the laparoscopic antireflux procedure. Results: We recorded 4/80 intraoperative complications; in all cases the complication was managed laparoscopically and no conversion was needed. Follow-up ranged from 6 months to 6 yrs (median 3 yrs). We recorded 24/80 postoperative complications, 5 of which required a redo procedure. We have a mortality rate of 17.5% but in only one case was the event related to the antireflux procedure. Conclusions: Laparoscopic fundoplication can be performed safely and with acceptable results in neurologically impaired children. The indication to add a gastrostomy should be tailored to the needs of the individual patient. Mortality rate in neurologically impaired children patients with gastroesophageal reflux disease is high but in most cases unrelated to the antireflux procedure.