Laparoscopic surgery for gastroesophageal reflux disease during the first year of life
Laparoscopic surgery for gastroesophageal reflux disease during the first year of life
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DOI：
10.1053/jpsu.2001.22943
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发表时间：
2001-05-01
影响因子：
2.4
通讯作者：
Reinberg, O
中科院分区：
文献类型：
--
作者：
Esposito, C;Montupet, P;Reinberg, O
背景：很少有儿童在出生后一年内需要胃食管反流手术；因此，到目前为止还没有出版任何系列。方法：1993年1月至1998年12月，36例23天至13个月大的胃食管反流病（GERD）患儿行腹腔镜手术。患者体重在2.4 - 8.5 kg之间。术前诊断检查包括食管造影、血压计、内窥镜检查和ph值测定。15例（41.6%）患儿有相关异常，10例（27.7%）患儿神经功能受损。36例腹腔镜下手术均采用Toupet法（17 / 36）、Rossetti法（10 / 36）、Nissen法（8 / 36）或lortta - jacob法（1 / 36）。4名婴儿先前接受了胃造口术，而6名婴儿在抗反流过程中需要进行胃造口术。结果：本研究中无死亡病例。3名婴儿（8.3%）出现术中并发症：1例膈血管病变，1例气胸，1例严重裂孔疝需要转开手术。在中位随访22个月期间，进行了4次重做手术（11.1%）。结论：这一经验表明，即使在1岁以下的儿童中，腹腔镜下扩底术也是可行的。准确的术前诊断研究是必要的，因为50%的患者出现相关异常。长期和准确的随访是必要的，以评估长期结果和发现可能的并发症，这些并发症可能发生在手术后1年。此外，根据我们对年龄较大的儿童的经验，我们相信腹腔镜下再做一次抗反流手术是可能的，没有很大的困难。[J]儿科外科杂志36:15 -717。W.B. Saunders Company版权所有(C) 2001。
Background: Very few children need gastroesophageal antireflux surgery during their first year of life; hence, no series has been published so far. The authors report their experience in 3 centers,Methods: From January 1993 to December 1998, 36 infants between 23 days and 13 months of age, suffering from gastroesophageal reflux disease (GERD), underwent surgery by a laparoscopic approach. The patients' weights ranged from 2.4 to 8.5 kg. Preoperative diagnostic studies included esophagograms, manometries, endoscopies, and pH-metries. Fifteen babies (41.6%) had associated anomalies, and 10 (27.7%) were neurologically impaired. Thirty-six laparoscopic fundoplications were performed according to either Toupet's procedure (17 of 36), Rossetti's (10 of 36), Nissen's (8 of 36) or Lortat-Jacob's (1 of 36). Four infants previously had undergone a gastrostomy, whereas 6 needed one during the antireflux procedure.Results: There was no mortality in our series. Three infants (8.3%) had an intraoperative complication: 1 lesion of a diaphragmatic vessel, 1 pneumothorax, and 1 case of severe hiatal hernia requiring conversion to open surgery. During the median follow-up of 22 months, 4 redo procedures were performed (11.1%).Conclusions: This experience shows the feasibility of laparoscopic fundoplication even in children below 1 year of age. An accurate preoperative diagnostic study is mandatory, because 50% of these patients presented associated anomalies. A long and accurate follow-up is necessary to evaluate long-term results and detect possible complications, which can occur as late as 1 year after surgery. In addition, we believe that redo antireflux surgery is possible by the laparoscopic approach without major difficulties, based on our larger experience with older children. J Pediatr Surg 36:715-717. Copyright (C) 2001 by W.B. Saunders Company.