A comparison of laparoscopic and open Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit population.
BACKGROUND
The aim of this study was to compare outcomes after laparoscopic and open techniques for Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit (NICU) population.


METHODS
The medical records for NICU inpatients who underwent laparoscopic and open Nissen fundoplication and gastrostomy placement from August 2002 to August 2008 were reviewed after Institutional Review Board approval. Each technique was compared with regard to operative time, estimated blood loss, postoperative 24-hour narcotic requirements, time to goal feeds, and complication rates. Analysis of variance was used to determine statistical significance. Data are quoted as mean +/- SEM.


RESULTS
Fifty-seven NICU patients underwent fundoplication and gastrostomy placement (25 laparoscopic and 32 open). The time to goal feeds was significantly shorter for the laparoscopic group (4.3 +/- 0.4 vs 6.1 +/- 0.6 days, P = .04). The 24-hour postoperative narcotic requirement was significantly lower in the laparoscopic group (0.24 +/- 0.05 vs 0.55 +/- 0.08 mg/kg, P = .007). Operation times (111 +/- 5 [open] vs 113 +/- 5 minutes, P = .76) and estimated blood loss (13 +/- 2 [open] vs 11 +/- 1 mL, P = .33) were comparable for both groups.


CONCLUSIONS
Laparoscopic and open techniques for Nissen fundoplication with gastrostomy placement are safe and appropriate treatment methods with equivalent operating times for the treatment of gastroesophageal reflux in the NICU population.
St Christopher's Hospital for Children/Drexel University College of Medicine, Philadelphia, PA 19134, USA.
Keith A
KA
Thatch
Edward Y
EY
Yoo
L Grier
LG
Arthur
Christine
C
Finck
Douglas
D
Katz
Matthew
M
Moront
Rajeev
R
Prasad
Charles
C
Vinocur
Marshall Z
MZ
Schwartz
D000293:Adolescent; D017677:Age Distribution; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D018662:Fundoplication / Q000379:methods* / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D009294:Narcotics