TY - JOUR
T1 - Laparoscopic proximal Roux-en-Y gastrojejunal diversion in children
T2 - Preliminary experience from a single center
AU - Mattioli, Girolamo
AU - Buffa, Piero
AU - Gandullia, Paolo
AU - Schiaffino, Maria Cristina
AU - Avanzini, Stefano
AU - Rapuzzi, Giovanni
AU - Prato, Alessio Pini
AU - Guida, Edoardo
AU - Costanzo, Sara
AU - Rossi, Valentina
AU - Basile, Angelina
AU - Montobbio, Giovanni
AU - Dellarocca, Mirta
AU - Mameli, Leila
AU - Disma, Nicola
AU - Pessagno, Alice
AU - Tomà, Paolo
AU - Jasonni, Vincenzo
PY - 2009/12/1
Y1 - 2009/12/1
N2 - Background: Neurologically impaired children (NIC) have a high risk of recurrence of gastroesophageal reflux (GER) following fundoplication. A postpyloric feeding tube may be useful when gastric emptying disorders occur; however, dislocation and difficulty in feeding management often require more aggressive procedures. Total esophagogastric dissociation (Bianchi's TEGD) is an alternative to the classic fundoplication procedure, whereas laparoscopic gastric bypass is a frequently performed procedure in morbid obesity, improving gastric outlet. Aim: The aim of this paper is to present a preliminary experience on the laparoscopic Roux-en-Y gastrojejunal bypass, associated with Nissen fundoplication and gastrostomy, to treat and prevent GER in NIC with gastric emptying disorders. Materials and Methods: Eight neurologically impaired children underwent surgical treatment because of feeding problems and pulmonary complications. The procedure included: 1) hiatoplasty, 2) Nissen fundoplication, 3) 20-cm Roux-en-Y gastrojejunal anastomosis and jejuno-jejunal anastomosis, and 4) gastrostomy. Results: All cases were fed on postoperative day 3 without any intraoperative complications. One case developed an obstruction of the distal anastomosis due to adhesion and needed reoperation. Outcome was clinically evaluated with serial upper gastrointestinal contrast studies and endoscopies. Conclusions: Laparoscopic proximal Roux-en-Y gastrojejunal diversion, without gastric resection, is a safe, feasible procedure that improves gastric emptying and reduces the risk of GER recurrence. Yet, long-term results still have to be evaluated.
AB - Background: Neurologically impaired children (NIC) have a high risk of recurrence of gastroesophageal reflux (GER) following fundoplication. A postpyloric feeding tube may be useful when gastric emptying disorders occur; however, dislocation and difficulty in feeding management often require more aggressive procedures. Total esophagogastric dissociation (Bianchi's TEGD) is an alternative to the classic fundoplication procedure, whereas laparoscopic gastric bypass is a frequently performed procedure in morbid obesity, improving gastric outlet. Aim: The aim of this paper is to present a preliminary experience on the laparoscopic Roux-en-Y gastrojejunal bypass, associated with Nissen fundoplication and gastrostomy, to treat and prevent GER in NIC with gastric emptying disorders. Materials and Methods: Eight neurologically impaired children underwent surgical treatment because of feeding problems and pulmonary complications. The procedure included: 1) hiatoplasty, 2) Nissen fundoplication, 3) 20-cm Roux-en-Y gastrojejunal anastomosis and jejuno-jejunal anastomosis, and 4) gastrostomy. Results: All cases were fed on postoperative day 3 without any intraoperative complications. One case developed an obstruction of the distal anastomosis due to adhesion and needed reoperation. Outcome was clinically evaluated with serial upper gastrointestinal contrast studies and endoscopies. Conclusions: Laparoscopic proximal Roux-en-Y gastrojejunal diversion, without gastric resection, is a safe, feasible procedure that improves gastric emptying and reduces the risk of GER recurrence. Yet, long-term results still have to be evaluated.
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U2 - 10.1089/lap.2008.0291
DO - 10.1089/lap.2008.0291
M3 - Article
C2 - 19405807
AN - SCOPUS:72049104218
VL - 19
SP - 807
EP - 813
JO - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A
JF - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A
SN - 1092-6429
IS - 6
ER -