학술논문
Effects of Anterior Fundoplication on Postoperative Dysphagia and Reflux After Laparoscopic Esophagocardiomyotomy for Pediatric Achalasia.
Document Type
Academic Journal
Author
French MP; Department of Surgery, Vanderbilt University, Nashville, Tennessee, USA.; Busing J; Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.; Acra S; Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.; Chen H; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA.; Stafman L; Department of Pediatric Surgery, Vanderbilt University, Nashville, Tennessee, USA.; Zamora I; Department of Pediatric Surgery, Vanderbilt University, Nashville, Tennessee, USA.; Holzman M; Department of Surgery, Vanderbilt University, Nashville, Tennessee, USA.; Lovvorn HN 3rd; Department of Pediatric Surgery, Vanderbilt University, Nashville, Tennessee, USA.
Source
Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 9706293 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-9034 (Electronic) Linking ISSN: 10926429 NLM ISO Abbreviation: J Laparoendosc Adv Surg Tech A Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Achalasia among children often fails endoscopic management (e.g., dilation, botulinum toxin). Laparoscopic esophagocardiomyotomy (L-ECM) is a standard intervention to relieve obstruction but can induce gastroesophageal reflux (GER). Concurrent anterior fundoplication (A-fundo) has been evaluated in randomized trials among adults, demonstrating mixed results on controlling postoperative GER without exacerbating dysphagia. Furthermore, evidence for the best approach among children remains sparse. We hypothesized that, among children undergoing L-ECM without mucosal violation, routine A-fundo would not improve postoperative GER control while exacerbating dysphagia. Materials and Methods: Observational data of 47 consecutive achalasia patients ≤18 years who received L-ECM (2002-2023) at a single academic institution were collected. Patient records were culled for demographics, achalasia characteristics, and outcomes. Two L-ECM groups were identified: with or without A-fundo. Patients were screened for postoperative dysphagia (additional procedures) and GER (new antireflux medications). Univariate independence testing was conducted to identify statistically significant variables. Results: Among 47 patients undergoing L-ECM, 28 (59.6%) received concurrent A-fundo. Compared with patients undergoing L-ECM alone, patients with L-ECM/A-fundo had significantly longer hospital stays ( P < .01) without statistically different rates of postoperative dysphagia ( P = .81) or GER ( P = .51). Five children (10.6%) experienced mucosal injury with L-ECM: 4 recognized intraoperatively received A-Fundo without subsequent leak; 1 mucosal injury was missed and did not receive A-Fundo, which subsequently leaked. Conclusion: In this largest observation of pediatric achalasia patients, A-fundo appeared clinically insignificant when determining contributors to control GER or exacerbate postoperative dysphagia. A-fundo should not be routinely adopted in children having L-ECM for achalasia without further multicenter analysis but appears beneficial in cases having inadvertent mucosal violation.