A comparison of laparoscopic and open Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit population

• Published in: Journal of pediatric surgery 2010-02, Vol.45 (2), p.346-349
• Main Authors: Thatch, Keith A, Yoo, Edward Y, Arthur, L. Grier, Finck, Christine, Katz, Douglas, Moront, Matthew, Prasad, Rajeev, Vinocur, Charles, Schwartz, Marshall Z
• Format: Article
• Language: English
• Subjects: Adolescent; Age Distribution; Blood Loss, Surgical - statistics & numerical data; Child; Child, Preschool; Enteral Nutrition - statistics & numerical data; Female; Fundoplication - methods; Fundoplication - statistics & numerical data; Gastroesophageal Reflux - surgery; Gastrostomy; Gastrostomy - methods; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal - statistics & numerical data; Intraoperative Period; Laparoscopic fundoplication; Laparoscopy - methods; Laparoscopy - statistics & numerical data; Length of Stay; Male; Narcotics - administration & dosage; Narcotics - therapeutic use; Neonatal antireflux surgery; Neonatal laparoscopy; Nissen fundoplication; Open fundoplication; Pain, Postoperative - drug therapy; Pain, Postoperative - epidemiology; Pediatrics; Postoperative Complications - epidemiology; Surgery; Time Factors; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2009.10.073

Abstract Introduction The aim of this study was to compare outcomes after laparoscopic and open techniques for Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit (NICU) population. Methods The medical records for NICU inpatients who underwent laparoscopic and open Nissen fundoplication and gastrostomy placement from August 2002 to August 2008 were reviewed after Institutional Review Board approval. Each technique was compared with regard to operative time, estimated blood loss, postoperative 24-hour narcotic requirements, time to goal feeds, and complication rates. Analysis of variance was used to determine statistical significance. Data are quoted as mean ± SEM. Results Fifty-seven NICU patients underwent fundoplication and gastrostomy placement (25 laparoscopic and 32 open). The time to goal feeds was significantly shorter for the laparoscopic group (4.3 ± 0.4 vs 6.1 ± 0.6 days, P = .04). The 24-hour postoperative narcotic requirement was significantly lower in the laparoscopic group (0.24 ± 0.05 vs 0.55 ± 0.08 mg/kg, P = .007). Operation times (111 ± 5 [open] vs 113 ± 5 minutes, P = .76) and estimated blood loss (13 ± 2 [open] vs 11 ± 1 mL, P = .33) were comparable for both groups. Conclusion Laparoscopic and open techniques for Nissen fundoplication with gastrostomy placement are safe and appropriate treatment methods with equivalent operating times for the treatment of gastroesophageal reflux in the NICU population.