Hopkins M A, Stringel G
Minimally Invasive Institute, New York Medical College, Westchester Medical Center, Valhalla, NY 10594, USA.
JSLS. 1999 Oct-Dec;3(4):261-6.
Adult laparoscopic Nissen fundoplication has been steadily growing since its introduction to the United States in the 1990s. Its advantage over the traditional open approach is manifold. Application of laparoscopic fundoplication to children is slowly but surely following this trend. This study evaluates our initial experience with pediatric laparoscopic Nissen fundoplications.
We reviewed the records of 25 consecutive laparoscopic Nissen fundoplications performed by a single surgeon (GS) at our institution in the past three years. The patient ages ranged from 7 months to 18 years (mean, 7 years). All patients had documented gastroesophageal reflux disease. Complications from the reflux included vomiting in 15 patients, failure to thrive in nine, esophagitis in nine, and pulmonary symptoms in six.
All Nissen fundoplications were performed laparoscopically without need for conversion to open technique. Blood loss was less than 50 cc in all cases. A tube gastrostomy was concurrently performed in 17. Mean operative time in all cases was 221 minutes. Average postoperative day on which feedings were begun was day 2, with an average resumption of regular feedings on postoperative day 3.5. Average date of discharge was postoperative day 6.8. Complications included difficulty controlling glucose in an insulin-dependent diabetic, and a lost needle, which added an additional hour to the operative time. There were eight admissions to the pediatric intensive care unit, all for observation secondary to their underlying medical problems. There was one postoperative death due to an underlying medical condition.
Laparoscopic Nissen fundoplication is a safe and effective treatment option for children suffering from significant reflux. Time to regular feeding, analgesia requirements and hospital stay are decreased when compared to traditional procedures. Laparoscopic Nissen fundoplication may well become the procedure of choice for pediatric gastroesophageal reflux disease.
自20世纪90年代引入美国以来，成人腹腔镜下尼氏胃底折叠术的应用一直在稳步增长。它相对于传统开放手术的优势是多方面的。腹腔镜胃底折叠术在儿童中的应用也正缓慢但稳步地遵循这一趋势。本研究评估了我们在小儿腹腔镜下尼氏胃底折叠术方面的初步经验。
我们回顾了过去三年中由同一外科医生（GS）在我们机构连续进行的25例腹腔镜下尼氏胃底折叠术的记录。患者年龄从7个月至18岁（平均7岁）。所有患者均有记录在案的胃食管反流病。反流引起的并发症包括15例呕吐、9例生长发育不良、9例食管炎和6例肺部症状。
所有尼氏胃底折叠术均通过腹腔镜完成，无需转为开放手术。所有病例的失血量均少于50毫升。17例同时进行了胃造瘘术。所有病例的平均手术时间为221分钟。开始喂养的平均术后天数为第2天，术后平均3.5天恢复正常喂养。平均出院日期为术后6.8天。并发症包括1例胰岛素依赖型糖尿病患者血糖控制困难，以及1根手术缝针丢失，这使手术时间增加了1小时。有8例患者入住儿科重症监护病房，均因基础疾病需要观察。有1例患者因基础疾病术后死亡。
腹腔镜下尼氏胃底折叠术是治疗严重反流患儿的一种安全有效的选择。与传统手术相比，恢复正常喂养的时间、镇痛需求和住院时间均有所减少。腹腔镜下尼氏胃底折叠术很可能成为小儿胃食管反流病的首选手术方式。
