title: Laparoscopic Nissen fundoplication in infants with hypoplastic left heart syndrome.
abstract: OBJECTIVE
  Patients with hypoplastic left heart syndrome (HLHS) experience a higher risk for complications from gastroesophageal reflux, prompting frequent need for fundoplication. Patients between stage I and II palliation ("interstage") are at particularly high operative risk because of the parallel nature of their pulmonary and systemic blood flow. Laparoscopic approach for fundoplication is common for pediatric patients. However, its safety in interstage HLHS is relatively unknown. We examined the perioperative physiologic burden of a laparoscopic fundoplication in HLHS patients.
  
  
  METHODS
  All patients who underwent open or laparoscopic fundoplication during the interstage period at our institution since 2006 were reviewed. Perioperative physiologic data, echocardiographic findings, survival, and complications were collected from the anesthetic record and patient chart.
  
  
  RESULTS
  Nineteen patients with HLHS had laparoscopic fundoplication, 13 (68%) during the interstage period, compared to 64 performed by the open approach. Ten (77%) of 13 interstage patients had perioperative hemodynamic instability. Incidence of instability between open and laparoscopic groups was not different. One laparoscopic patient required ECMO support for shunt thrombosis.
  
  
  CONCLUSIONS
  Despite a high incidence of hemodynamic instability, overall outcomes are consistent with those reported in the literature for this high-risk patient population. Laparoscopic approach for fundoplication during the interstage period appears to be a relatively safe option for these patients.
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Craig
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Rellinger
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Bret A
authors.initials: BA
authors.lastname: Mettler
authors.affiliation: Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Watkins
authors.affiliation: Division of Pediatric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Donahue
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: dai.chung@vanderbilt.edu.
authors.forename: Dai H
authors.initials: DH
authors.lastname: Chung
mesh_terms: D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hypoplastic left heart syndrome; Interstage; Laparoscopy; Pediatric; Surgery