Koga Yoshinori, Sugita Koshiro, Hashizume Naoki, Masui Daisuke, Nakame Kazuhiko, Onishi Shun, Torikai Motofumi, Ieiri Satoshi, Kaji Tatsuru
Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan.
Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.
Surg Today. 2025 Jun 4. doi: 10.1007/s00595-025-03067-1.
Postural features (e.g. scoliosis) make laparoscopic fundoplication more difficult in neurologically impaired patients (NIPs) than in non-NIPs [please check this carefully]. We therefore clarified the relevant factors associated with perioperative outcomes of NIPs.
NIPs who underwent laparoscopic Nissen fundoplication were enrolled. We classified the patients according to age into < 18- and ≥ 18-year-old groups and evaluated the factors associated with perioperative outcomes. The endpoints were patient characteristics, acid-reflux index, operative time, blood loss, postoperative outcomes, and Endoscopic Surgical Skill Qualification System (ESSQS) certification.
One hundred and one patients underwent laparoscopic fundoplication. Blood loss and operative time were significantly higher in the ≥ 18-year-old group than in the < 18-year-old group. A multivariate regression analysis revealed that no factors were significantly associated with blood loss. However, a significant association was observed between the procedure performed by the ESSQS-certified pediatric surgeon and the operative time. In terms of postoperative outcomes, the length of hospital stay after operations performed or supervised by ESSQS-certified pediatric surgeons was significantly shorter than that after operations performed by pediatric surgeons without ESSQS certification.
The involvement of pediatric surgeons with ESSQS certification was significantly associated with perioperative outcomes in NIPs during laparoscopic fundoplication, whereas physical characteristics and GER were not.
Level III, case-control study.
与非神经功能受损患者相比，神经功能受损患者（NIPs）的姿势特征（如脊柱侧弯）使腹腔镜胃底折叠术的难度增加[请仔细核对这点]。因此，我们阐明了与NIPs围手术期结局相关的因素。
纳入接受腹腔镜Nissen胃底折叠术的NIPs。我们根据年龄将患者分为<18岁组和≥18岁组，并评估与围手术期结局相关的因素。终点指标包括患者特征、酸反流指数、手术时间、失血量、术后结局以及内镜手术技能资格认证系统（ESSQS）认证。
101例患者接受了腹腔镜胃底折叠术。≥18岁组的失血量和手术时间显著高于<18岁组。多因素回归分析显示，没有因素与失血量显著相关。然而，观察到ESSQS认证的儿科外科医生进行的手术与手术时间之间存在显著关联。在术后结局方面，ESSQS认证的儿科外科医生实施或监督的手术后住院时间显著短于未获得ESSQS认证的儿科外科医生实施的手术后住院时间。
在腹腔镜胃底折叠术中，ESSQS认证的儿科外科医生的参与与NIPs的围手术期结局显著相关，而身体特征和胃食管反流则不然。
III级，病例对照研究。
