Liu D C, Flattmann G J, Karam M T, Siegrist B I, Loe W A, Hill C B
Children's Hospital of New Orleans, LA 70118, USA.
J Pediatr Surg. 2000 Feb;35(2):334-7. doi: 10.1016/s0022-3468(00)90035-6.
BACKGROUND/PURPOSE: In our institution, many children requiring antireflux surgery for gastroesophageal reflux have had previous abdominal surgery, usually gastrostomy tube or ventriculoperitoneal (VP) shunt placement. The authors review their laparoscopic Nissen fundoplication (LNF) experience in children with previous abdominal surgery assessing surgical outcome.
A total of 82 consecutive LNFs performed at our institution between January 1996 and September 1998 were reviewed. Follow-up ranged from 1 month to 32 months (average, 8.9 months). LNF was performed without dividing short gastric vessels (Rosetti modification) through a standard 5-port technique.
A total of 26 of 82 patients (31.7%) had previous abdominal surgery and were divided into 2 groups: gastrostomy (n = 17) and VP shunt (n = 11) with 2 crossovers. A total of 14 of 17 (82.3%) in the gastrostomy group had percutaneous endoscopic gastrostomy (PEG) placement versus 3 of 17 (17.6%) by open technique (open). Four patients in the VP group had multiple surgeries (range, 1 to 10, average, 2.3). LNF was completed in 25 of 26 (96.2%). One operation was converted to an open procedure because of severe adhesions. In 13 of 17 (76.5%) the previous gastrostomy was not taken down. In 4 of 17 (23.5%), the gastrostomy was taken down to complete the procedure: 2 of 3 (66.7%) of the open group versus 2 of 14 (14.3%) of the PEG group. All 11 (100%) of the VP group had successful LNF. Two of 11 (18.2%) had shunt dysfunction at 2 months (shunt infection) and 4 months (clogged distal shunt), respectively. There have been no cases of recurrent reflux, and all gastrostomies and VP shunts were functional at the time of this report.
Previous abdominal surgery is common in children with gastroesophageal reflux disease requiring an antireflux procedure. The authors conclude from these preliminary results that laparoscopic Nissen fundoplication can be performed safely with minimal morbidity and excellent functional results in children with gastrostomies or ventriculoperitoneal shunts.
背景/目的：在我们机构，许多因胃食管反流需要进行抗反流手术的儿童此前已接受过腹部手术，通常是胃造口管置入术或脑室腹腔（VP）分流术。作者回顾了他们在曾接受腹部手术的儿童中进行腹腔镜Nissen胃底折叠术（LNF）的经验，评估手术结果。
回顾了1996年1月至1998年9月在我们机构连续进行的82例LNF手术。随访时间为1个月至32个月（平均8.9个月）。通过标准的五孔技术进行LNF，不切断胃短血管（罗塞蒂改良法）。
82例患者中有26例（31.7%）曾接受过腹部手术，分为两组：胃造口术组（n = 17）和VP分流术组（n = 11），有2例交叉。胃造口术组17例中有14例（82.3%）采用经皮内镜胃造口术（PEG）置入，17例中有3例（17.6%）采用开放技术（开放手术）。VP组有4例患者接受过多次手术（范围为1至10次，平均2.3次）。26例中有25例（96.2%）完成了LNF。1例手术因严重粘连转为开放手术。17例中有13例（76.5%）未拆除先前的胃造口。17例中有4例（23.5%）拆除胃造口以完成手术：开放手术组3例中有2例（66.7%），PEG组14例中有2例（14.3%）。VP组所有11例（100%）LNF手术均成功。11例中有2例（18.2%）分别在2个月（分流感染）和4个月（远端分流堵塞）时出现分流功能障碍。截至本报告时，无复发性反流病例，所有胃造口和VP分流均功能正常。
在需要进行抗反流手术的胃食管反流病儿童中，先前的腹部手术很常见。作者从这些初步结果得出结论，对于有胃造口或脑室腹腔分流的儿童，腹腔镜Nissen胃底折叠术可以安全地进行，发病率极低，功能效果良好。
