Purpose Children with neurologic and neuromuscular handicaps frequently have v arious symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in su...Purpose Children with neurologic and neuromuscular handicaps frequently have v arious symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study. Methods Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), an d gastrostomy was performed concurrently in 52.The main symptoms were emesis/he matemesis in 40 and respiratory symptoms, including repeated respiratory infecti on and distress, in 31.Results There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those w ithout recurrence. Respiratory symptoms were controlled unsuccessfully in 16 pat ients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease o ccurred in 10 patients, 7 of whom underwent a second Nissen fundoplication succe ssfully. Thirteen died within the median follow-up period of 14 months. Conclus ions Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped chi ldren. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.展开更多
文摘Purpose Children with neurologic and neuromuscular handicaps frequently have v arious symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study. Methods Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), an d gastrostomy was performed concurrently in 52.The main symptoms were emesis/he matemesis in 40 and respiratory symptoms, including repeated respiratory infecti on and distress, in 31.Results There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those w ithout recurrence. Respiratory symptoms were controlled unsuccessfully in 16 pat ients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease o ccurred in 10 patients, 7 of whom underwent a second Nissen fundoplication succe ssfully. Thirteen died within the median follow-up period of 14 months. Conclus ions Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped chi ldren. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.
