Laparoscopic Nissen fundoplication in infants with hypoplastic left heart syndrome. J Pediatr Surg 2016 Jan;51(1):76-80
Date
11/18/2015Pubmed ID
26572850DOI
10.1016/j.jpedsurg.2015.10.013Scopus ID
2-s2.0-84952975332 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
BACKGROUND/PURPOSE: Patients with hypoplastic left heart syndrome (HLHS) experience a higher risk for complications from gastroesophageal reflux, prompting frequent need for fundoplication. Patients between stage I and II palliation ("interstage") are at particularly high operative risk because of the parallel nature of their pulmonary and systemic blood flow. Laparoscopic approach for fundoplication is common for pediatric patients. However, its safety in interstage HLHS is relatively unknown. We examined the perioperative physiologic burden of a laparoscopic fundoplication in HLHS patients.
METHODS: All patients who underwent open or laparoscopic fundoplication during the interstage period at our institution since 2006 were reviewed. Perioperative physiologic data, echocardiographic findings, survival, and complications were collected from the anesthetic record and patient chart.
RESULTS: Nineteen patients with HLHS had laparoscopic fundoplication, 13 (68%) during the interstage period, compared to 64 performed by the open approach. Ten (77%) of 13 interstage patients had perioperative hemodynamic instability. Incidence of instability between open and laparoscopic groups was not different. One laparoscopic patient required ECMO support for shunt thrombosis.
CONCLUSIONS: Despite a high incidence of hemodynamic instability, overall outcomes are consistent with those reported in the literature for this high-risk patient population. Laparoscopic approach for fundoplication during the interstage period appears to be a relatively safe option for these patients.
Author List
Craig BT, Rellinger EJ, Mettler BA, Watkins S, Donahue BS, Chung DHAuthor
Brian T. Craig MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
FemaleFundoplication
Gastroesophageal Reflux
Hemodynamics
Humans
Hypoplastic Left Heart Syndrome
Infant
Infant, Newborn
Laparoscopy
Male
Retrospective Studies
Treatment Outcome
