Format

Send to:

Choose Destination
See comment in PubMed Commons below
Eur J Pediatr Surg. 2004 Apr;14(2):89-92.

Laparoscopic fundoplication in neurologically impaired children with percutaneous endoscopic gastrostomy.

Author information

  • 1Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. Jesch.Natalie@mh-hannover.de

Abstract

TOPIC:

Laparoscopic fundoplication is the preferred surgical procedure for children with gastro-oesophageal reflux. Little data exist on the feasibility of laparoscopic fundoplication after placement of a percutaneous endoscopic gastrostomy (PEG).

PATIENTS AND METHODS:

Thirty-nine children aged 4 months to 18 years (median 3.6 years) presented for an antireflux procedure between November 2000 and July 2003. The surgical technique used was the Thal (270 degrees ) fundoplication. Clinical data, technical aspects of the operation, and the postoperative course were collected prospectively.

RESULTS:

Twenty-two children (56 %), all of them neurologically impaired, already had a PEG in place due to feeding problems irrespective of gastro-oesophageal reflux symptoms. In all cases, laparoscopic fundoplication was performed immediately after gastroscopic removal of the PEG tube. In two cases, conversion to an open procedure became necessary, due to reasons unrelated to the PEG. In one case conversion was necessary because of adhesions of an intrathoracic stomach and in the other case because of circulatory problems due to congenital cardiomyopathy. In one patient, the gastrostomy was moved at the end of the procedure because it was too close to the antrum. In two further cases, the gastrostomy detached during fundoplication. In this case, the gastrostomy catheter was replaced and secured laparoscopically with a purse-string suture. All other cases were without any complications and a balloon tube or a button was placed into the existing gastrostomy channel at the end of surgery.

CONCLUSION:

No adverse effects are associated with PEG placement prior to a consecutive laparoscopic antireflux procedure. Possible detachment of the pre-existing gastrostomy must be excluded at the end of the procedure.

PMID:
15185153
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Georg Thieme Verlag Stuttgart, New York
    Loading ...
    Write to the Help Desk