Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome.
OBJECTIVE
Laparoscopy has advanced the care of children for a variety of pediatric surgical diseases. However, complication rates for laparoscopic interventions in neonates with hypoplastic left heart syndrome (HLHS) have not been well described. The purpose of this study is to present the largest reported series of laparoscopic surgery performed in patients with HLHS.


METHODS
We conducted a single-institution, retrospective chart review for all neonates with HLHS who underwent a laparoscopic procedure from September 2002 to March 2005. Data regarding patient characteristics, intraoperative monitoring, previous cardiac surgery, perioperative complications, and postoperative mortality were assessed.


RESULTS
Twelve patients with HLHS underwent a total of 13 operations during the study period (8 combined Nissen fundoplication and gastrostomy tubes, 3 isolated gastrostomy tubes, 1 Ladd procedure, and 1 combined Nissen fundoplication and gastrocutaneous fistula closure). All cases were completed laparoscopically. Patients had undergone palliative cardiac surgery but were not completely corrected; therefore, they were cyanotic. Perioperative complications were observed in 6 patients (3 gastrostomy tube site infections, 1 small bowel obstruction, 1 postoperative sepsis, and 1 urinary tract infection). There was no mortality in this series.


CONCLUSIONS
From this experience, it appears that laparoscopy can be performed safely and with satisfactory outcomes in patients with HLHS. However, a multidisciplinary approach, including the availability of a skilled and experienced cardiac anesthesia team, is believed to be critical to optimize outcomes in these critically ill children.
Slater
Bethany
B
Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, Lucile Packard Children's Hospital, Stanford, CA, USA.
Rangel
Shawn
S
Ramamoorthy
Chandra
C
Abrajano
Claire
C
Albanese
Craig T
CT
D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D017577:Cutaneous Fistula / Q000601:surgery; D004750:Enteral Nutrition; D005260:Female; D018662:Fundoplication; D005747:Gastric Fistula / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D010166:Palliative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome