Laparoscopic proximal Roux-en-Y gastrojejunal diversion in children: Preliminary experience from a single center

Girolamo Mattioli, Piero Buffa, Paolo Gandullia, Maria Cristina Schiaffino, Stefano Avanzini, Giovanni Rapuzzi, Alessio Pini Prato, Edoardo Guida, Sara Costanzo, Valentina Rossi, Angelina Basile, Giovanni Montobbio, Mirta Dellarocca, Leila Mameli, Nicola Disma, Alice Pessagno, Paolo Tomà, Vincenzo Jasonni

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Abstract

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.

Original languageEnglish
Pages (from-to)807-813
Number of pages7
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume19
Issue number6
DOIs
Publication statusPublished - Dec 1 2009

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ASJC Scopus subject areas

  • Surgery

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