Laparoscopic proximal Roux-en-Y gastrojejunal diversion in children: preliminary experience from a single center.
BACKGROUND
Neurologically impaired children (NIC) have a high risk of recurrence of gastroesophageal reflux (GER) following fundoplication. A postpyloric feeding tube may be useful when gastric emptying disorders occur; however, dislocation and difficulty in feeding management often require more aggressive procedures. Total esophagogastric dissociation (Bianchi's TEGD) is an alternative to the classic fundoplication procedure, whereas laparoscopic gastric bypass is a frequently performed procedure in morbid obesity, improving gastric outlet.


OBJECTIVE
The aim of this paper is to present a preliminary experience on the laparoscopic Roux-en-Y gastrojejunal bypass, associated with Nissen fundoplication and gastrostomy, to treat and prevent GER in NIC with gastric emptying disorders.


METHODS
Eight neurologically impaired children underwent surgical treatment because of feeding problems and pulmonary complications. The procedure included: 1) hiatoplasty, 2) Nissen fundoplication, 3) 20-cm Roux-en-Y gastrojejunal anastomosis and jejuno-jejunal anastomosis, and 4) gastrostomy.


RESULTS
All cases were fed on postoperative day 3 without any intraoperative complications. One case developed an obstruction of the distal anastomosis due to adhesion and needed reoperation. Outcome was clinically evaluated with serial upper gastrointestinal contrast studies and endoscopies.


CONCLUSIONS
Laparoscopic proximal Roux-en-Y gastrojejunal diversion, without gastric resection, is a safe, feasible procedure that improves gastric emptying and reduces the risk of GER recurrence. Yet, long-term results still have to be evaluated.
Mattioli
Girolamo
G
Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
Buffa
Piero
P
Gandullia
Paolo
P
Schiaffino
Maria Cristina
MC
Avanzini
Stefano
S
Rapuzzi
Giovanni
G
Pini Prato
Alessio
A
Guida
Edoardo
E
Costanzo
Sara
S
Rossi
Valentina
V
Basile
Angelina
A
Montobbio
Giovanni
G
DellaRocca
Mirta
M
Mameli
Leila
L
Disma
Nicola
N
Pessagno
Alice
A
Tomà
Paolo
P
Jasonni
Vincenzo
V
D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication; D015390:Gastric Bypass; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome