title: Laparoscopic proximal Roux-en-Y gastrojejunal diversion in children: preliminary experience from a single center.
abstract: 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.
authors.affiliation: Department of Pediatric Surgery, Gaslini Research Institute and Children's Hospital, Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.forename: Piero
authors.initials: P
authors.lastname: Buffa
authors.forename: Paolo
authors.initials: P
authors.lastname: Gandullia
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Schiaffino
authors.forename: Stefano
authors.initials: S
authors.lastname: Avanzini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rapuzzi
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini Prato
authors.forename: Edoardo
authors.initials: E
authors.lastname: Guida
authors.forename: Sara
authors.initials: S
authors.lastname: Costanzo
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.forename: Angelina
authors.initials: A
authors.lastname: Basile
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montobbio
authors.forename: Mirta
authors.initials: M
authors.lastname: DellaRocca
authors.forename: Leila
authors.initials: L
authors.lastname: Mameli
authors.forename: Nicola
authors.initials: N
authors.lastname: Disma
authors.forename: Alice
authors.initials: A
authors.lastname: Pessagno
authors.forename: Paolo
authors.initials: P
authors.lastname: Tomà
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Jasonni
mesh_terms: 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