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• W2037447036 abstract "Introduction: Few published studies evaluate outcomes of Open Nissen fundoplication (ONF) and Laparoscopic Nissen Fundoplication (LNF) used to manage pediatric GERD. We characterized surgical management of refractory GERD in children <5 years old (1997–02) including indications for ONF compared to LNF, and the short and long-term outcome via follow up phone call and records review. Methods: For the years 1997–99, we performed a retrospective study of all children <5 years who received LNF or ONF at our institution where five pediatric surgeons routinely perform anti-reflux surgery. Pre-surgical evaluations, surgical indications, and hospital course data were obtained from hospital charts. Long-term outcome follow-up was obtained via a uniformly applied phone survey. For the years 2000–02, we compared the two procedures by: pre-operative evaluation, indications for surgery and predictors of surgical approach compared with the previous three years. Results: Overall, 374 cases were analyzed. For the years 1997–99, early outcome data parameters were obtained from 222 patients (122 ONF vs.100 LNF); median age was 7 months (range 1–60 months). Fundoplication for primary GERD was done on 37 (16.7%) cases, while 185 (83%) were performed for GERD in conjunction with a pre-existing co-morbidity of which neurological impairment was the most common. In 1997–99, more fundoplications were performed on children who had a major co-morbidity by ONF 108 (58%) vs. LNF 77 (42%) (p = 0.02). During the subsequent 3 years (2000–02), there was a change in approach with significantly more surgeries performed by LNF 144 (94.7%) vs. ONF 8 (5.3%), even when co-morbidities were present. For the first three years reviewed, the mean operative time was 96 ±36.6 min. for ONF versus 111±46.6 min. for LNF (p = 0.008) and mean hospital stay was less in LNF (p< 0.005). Early complications were more common in the ONF group (p <0.005) and long-term data showed a trend to a more frequent evaluation of wrap integrity in the ONF. Wrap failure rates were more frequent in LNF and occurred significantly earlier in LNF (p< 0.005). Conclusion: Acute and long-term complications and the overall procedure cost appeared to be greater in ONF compared to LNF. Wrap failure rates are comparable in either technique but presented earlier in LNF. Surgeon experience and preferred technique appear to be the most important predictors of surgical success and technique (LNF vs. ONF). Our study suggest that LNF may be the favorable approach for surgical management of pediatric GERD, even when pre-existing co-morbidities are present." @default.
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• W2037447036 date "2004-06-01" @default.
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• W2037447036 title "P0761 SURGICAL OUTCOMES IN THE MANAGEMENT OF PEDIATRIC GASTROESOPHAGEAL REFLUX DISEASE (GERD)" @default.
• W2037447036 doi "https://doi.org/10.1097/00005176-200406001-00885" @default.
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