Open versus laparoscopic approach to gastric fundoplication in children with cardiac risk factors.
J Surg Res
; 220: 52-58, 2017 12.
Article
en En
| MEDLINE
| ID: mdl-29180211
ABSTRACT
BACKGROUND:
Gastric fundoplication is the most common noncardiac operation in children with congenital cardiac disease. While prior studies validated safety of laparoscopy in this population, we hypothesize that children with cardiac risk factors (CRFs) are likelier to undergo open fundoplication (OF) but experience greater morbidity than after laparoscopic fundoplication (LF). MATERIALS ANDMETHODS:
Utilizing 2013 National Surgical Quality Improvement Program-Pediatrics Public-Use-File, pediatric patients undergoing LF and OF were stratified to none, minor, major, or severe CRFs. Multivariate logistic regression determined preoperative variables and postoperative outcomes associated with LF or OF.RESULTS:
A total of 1501 fundoplication patients were identified with 92% undergoing LF. OF patients were likelier to have minor (odds ratio [OR] 2.36, P < 0.001), major (OR 2.41, P = 0.003), and severe CRFs (OR 4.36, P < 0.001). Children ≤ 1 y (OR 3.38, P = 0.048) and those with tracheostomy were likelier to have OF (OR 2.3, P = 0.006). Overall, the OF group had higher postoperative morbidity (OR 2.41, P < 0.001). Specifically, children with minor or major CRFs experienced more complications following OF compared to LF.CONCLUSIONS:
OF is more common in patients ≤1 y old; patients with minor, major, or severe CRFs; and those with tracheostomy. LF should be considered in children with minor and major CRFs, as OF in those patients results in greater pulmonary, infectious, and hematological sequelae.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Reflujo Gastroesofágico
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Laparoscopía
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Fundoplicación
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Cardiopatías Congénitas
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
J Surg Res
Año:
2017
Tipo del documento:
Article