Effectiveness of Robotic Assisted Laparoscopic Nissen fundoplication in neurologically impaired children with severe gastroesophageal reflux disease

Abstract

Background: Laparoscopic Nissen Fundoplication is still the most widely used surgical technique in the treatment of gastroesophageal reflux disease (GERD) in children. However, there are some technical and anatomical difficulties in the treatment of reflux in NIC with GERD. All these difficulties lead to the high rate of surgical failure observed in neurological impaired children (NIC). Robotic surgery provides a number of advantages in overcoming these difficulties. This study is the first study to evaluate the effectiveness of robotic surgery in the treatment of GERD in children with severe or moderate neurological impairments reported in our country. Patients and Methods: This study was performed between January 2018 and February 2020. The records of eleven children with severe or moderate neurological problems who were treated by using robotically assisted laparoscopic Nissen fundoplication (RALNF) technique were evaluated for demographic data, anesthesia time, pre-console time, console time, and postoperative complications retrospectively. Results: Nine of the patients (81.8%) had serious neurological problems and two patients had moderate neurological problems. All of the patients applied to the emergency department at different times due to recurrent lung infections. While the first RALNF console time was 240 minutes, it was determined that this time was reduced to 45 minutes. None of the patients had complications related to the surgical procedure, but four of 11 patients required postoperative intensive care unit for some problems NIC depended requirements up to two months. Conclusion: RALNF can be safely applied in pediatric patients with GERD with severe and moderate NIC.

Keywords

• Fundoplication
• gastroesophageal reflux
• laparoscopy
• neurologic disorders
• robotic surgical procedures

Nörolojik bozukluğu olan çocuklarda ağır gastroözofageal reflü hastalığı nedeniyle yapılan Robotik Yardımlı Laparoskopik Nissen fundoplikasyonunun etkinliği

Abstract

Amaç: Laparoskopik Nissen Fundoplikasyon, çocuklarda gastroözofageal reflü hastalığının (GÖRH) tedavisinde hala en yaygın kullanılan cerrahi tekniktir. Ancak GÖRH ile Nörolojik problemli çocuklarda (NPÇ) reflü tedavisinde bazı teknik ve anatomik zorluklar vardır. Tüm bu zorluklar, nörolojik problemli olan çocuklarda gözlenen yüksek oranda cerrahi başarısızlığa yol açmaktadır. Robotik cerrahi bu zorlukların aşılmasında bir takım avantajlar sağlamaktadır. Bu çalışma, ülkemizde bildirilen ciddi veya orta derecede nörolojik bozukluğu olan çocuklarda GÖRH tedavisinde robotik cerrahinin etkinliğini değerlendiren ilk çalışmadır. Hastalar ve Yöntemler: Bu çalışma Ocak 2018-Şubat 2020 tarihleri arasında yapıldı. Robotik yardımlı laparoskopik Nissen fundoplikasyon (RYNF) tekniği ile tedavi edilen ağır ve orta derecede nörolojik sorunu olan on bir çocuğun kayıtları geriye dönük olarak değerlendirildi; demografik veriler, anestezi süresi, konsol öncesi zamanı, konsol zamanı ve ameliyat sonrası komplikasyonlar. Bulgular: Hastaların 9'unda (%81.8) ciddi nörolojik problemler vardı ve 2 hastada orta derecede nörolojik problemler vardı. Hastaların tamamı tekrarlayan akciğer enfeksiyonları nedeniyle farklı zamanlarda acil servise başvurdu. İlk RYNF konsol süresi 240 dakika iken bu sürenin 45 dakikaya indirildiği belirlendi. Hastaların hiçbirinde cerrahi işleme bağlı komplikasyon görülmedi, ancak 11 hastadan dördü iki aya kadar NPÇ'ye bağlı bazı problemler nedeniyle postoperatif yoğun bakım ünitesine ihtiyaç duydu. Sonuç: RYNF, şiddetli ve orta NPÇ'li pediatrik GÖRH hastalarında güvenle uygulanabilir.

Keywords

• Fundoplikasyon
• gastroözofageal reflü
• laparoskopi
• nörolojik bozukluklar
• robotik cerrahi işlemler

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