Document Detail


A roadmap for the establishment of pediatric laparoscopic fundoplication.
MedLine Citation:
PMID:  19215205     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: The way to introduce laparoscopic fundoplication (LF) to a pediatric surgical unit has not been well described. We have taken a measured approach to introducing LF and report our experience in this paper. METHODS: All patients undergoing LF from the first case in April 2003 to December 2007 were reviewed retrospectively. Cases were identified from theater and discharge databases, and data were captured by using a structured proforma. RESULTS: Eighty-five LFs were performed on 51 males and 34 females, with a median age of 46.5 months (range, 2-218). Fifty-one cases (60%) were neurologically impaired; a further 26 (31%) had significant comorbidity. Seventy-eight (92%) cases were performed by, or under the supervision of, the two senior authors. The first 10 cases were performed under the mentorship of a visiting surgeon from an established pediatric laparoscopic center. Thereafter, LF was conducted as a two- then a one-consultant operation and was finally performed primarily by trainees under consultant supervision. The total number of LFs increased from 4 in 2003 to 29 in 2007. Nine major complications occurred in 8 patients (5 gastric perforations, 1 colonic gastrostomy tube insertion, 1 nasogastric tube sutured into a wrap, 1 midgut, and 1 gastric volvulus). Seven cases required a conversion to an open fundoplication. There was no 30-day mortality. Six patients have died since surgery; in none of the patients was the LF implicated. CONCLUSION: We recommend a measured approach to the introduction of LF with the transition from mentorship to local consultant practice and, finally, to a trainee procedure under consultant supervision. This approach yielded satisfactory results while minimising the disruption to trainee experience.
Authors:
Timothy Bradnock; Phillip Hammond; Graham Haddock; Atul Sabharwal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of laparoendoscopic & advanced surgical techniques. Part A     Volume:  19 Suppl 1     ISSN:  1092-6429     ISO Abbreviation:  J Laparoendosc Adv Surg Tech A     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-11-25     Completed Date:  2009-12-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706293     Medline TA:  J Laparoendosc Adv Surg Tech A     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S41-5     Citation Subset:  IM    
Affiliation:
Department of Pediatric Surgery, The Royal Hospital for Sick Children, Glasgow, Scotland. tjbradnock@doctors.org.uk
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Female
Fundoplication / methods*
Humans
Infant
Laparoscopy / methods*
Male
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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