Högberg Niclas, Danielson Johan, Westblom Amanda, Gustafson Elisabet
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Section of Pediatric Surgery, Uppsala University, Akademiska Sjukhuset, 75185, Uppsala, Sweden.
Pediatr Surg Int. 2025 Jan 16;41(1):66. doi: 10.1007/s00383-025-05968-1.
Nissen fundoplication is one of the most common surgical procedures for gastroesophageal reflux. Current and previous research comparing laparoscopic Nissen fundoplication (LNF) versus open Nissen fundoplication (ONF) in children suggest ambiguous conclusions. The purpose of this retrospective study was to compare the outcome for children operated with LNF or ONF at our institution and to evaluate the economic aspects.
32 consecutive patients (LNF: n = 18, ONF: n = 14) operated with Nissen fundoplication between the years 2011-2017 were included in the study. Data was collected by examination of the patient journals and preoperative, operative, postoperative, and post-discharge parameters were analyzed.
Compared to ONF, the LNF group had shorter operating time (165.2 vs 216.6 min, p < 0.05), shorter overall operating room duration (315.0 vs 334.9 min, p < 0.05) and shorter postoperative hospital stay (3.8 vs 8.1 days, p < 0.05). The LNF group also required less morphine (1.2 vs 1.7 mg/kg, p < 0.05) and the total cost per case was 39% lower (261.1 vs 427.4 kSEK, p < 0.05). No difference was seen in postoperative complications and results.
Laparoscopic Nissen fundoplication is more cost-effective compared to open surgery and reduces postoperative hospital stay and morphine requirements.
nissen胃底折叠术是治疗胃食管反流最常见的外科手术之一。目前及以往比较儿童腹腔镜nissen胃底折叠术（LNF）与开放nissen胃底折叠术（ONF）的研究结果并不明确。本回顾性研究的目的是比较在我们机构接受LNF或ONF手术的儿童的治疗效果，并评估经济方面的情况。
本研究纳入了2011年至2017年间连续接受nissen胃底折叠术的32例患者（LNF组：n = 18，ONF组：n = 14）。通过查阅患者病历收集数据，并分析术前、术中、术后及出院后的参数。
与ONF组相比，LNF组手术时间更短（165.2分钟对216.6分钟，p < 0.05），总手术室时长更短（315.0分钟对334.9分钟，p < 0.05），术后住院时间更短（3.8天对8.1天，p < 0.05）。LNF组所需吗啡量也更少（1.2毫克/千克对1.7毫克/千克，p < 0.05），且每例总成本低39%（261.1千瑞典克朗对427.4千瑞典克朗，p < 0.05）。术后并发症及结果未见差异。
与开放手术相比，腹腔镜nissen胃底折叠术更具成本效益，可缩短术后住院时间并减少吗啡需求量。
