[Laparoscopy-assisted jejunostomy in neurological patients with chronic malnutrition and GERD. Technical considerations and analysis of the results].
BACKGROUND
Feeding difficulties and gastroesophageal reflux (GER) are major problems in severely neurologically impaired children. Many patients are managed with a simple gastrostomy, with or without fundoplication. Unfortunately, fundoplication and gastrostomy are not devoid of complications, indicating the need for other options in the management of these patients.


METHODS
Between January 2002 and June 2010, ten patients (age range, 18 months-14 years) have been treated by creating a jejunostomy with the laparoscopic-assisted procedure. The procedure was performed using 2-3 trocars. The technique consists of identifying the first jeujnal loop, grasping it 20-30 cm away from the Treitz ligament, and exteriorizing it to the trocar orifice under visual guide. The jejunostomy was created outside the abdominal cavity during open surgery. At the end of the jejunostomy, the correct position of the intestinal loops was evaluated via laparoscopy.


RESULTS
Surgery lasted 40 min on average, the laparoscopic portion about 10 min. Hospital stay was 3 or 7 days for all patients. At the longest follow-up (8 years), all patients had experienced a significant weight gain. One patient died 1 year after the procedure of unknown causes. As for the other complications: 4/10 patients experienced peristomal heritema, 2/10 device's dislocation and 1 patient a peristomal granuloma.


CONCLUSIONS
Laparoscopic-assisted jejunostomy is a safe and effective procedure to adopt in neurologically impaired children with feeding problems and GER. We advocate the use of this procedure in neurologically impaired patients with feeding problems and reflux due to its overall practicability and because there is minimal surgical trauma. The improvement in the quality of life of these children after the jejunostomy seems to be the major advantage of this procedure. However the management of jejunostomy can be difficult for parents above all in the first postoperative months.
Chirurgia Pediatrica Università, di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italia. ciroespo@unina.it
C
C
Esposito
F
F
Alicchio
M
M
Escolino
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G
Ascione
A
A
Settimi
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000601:surgery*; D009422:Nervous System Diseases / Q000150:complications*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain