Evaluating the Perioperative Outcomes of Laparoscopic Fundoplication in One Hundred Neurologically Impaired Patients : A Multicenter Retrospective Joint Study

Abstract

Background: Neurologically impaired patients (NIPs) with gastroesophageal reflux disease (GERD) require the fundoplication. Their postural feature such as scoliosis makes it more difficult to perform laparoscopic fundoplication. We aimed to clarify risk factors of laparoscopic fundoplication for NIPs and analyzed the perioperative impact of surgery performed by ESSQS-certified pediatric surgeons. Methods: NIPs who underwent laparoscopic fundoplication were registered. First, we classified the patients according to age into the <18 years and ≥18 years groups, and then further classified them according to whether the procedure was performed by a board-certified pediatric surgeon. The evaluation endpoints were patient characteristics, acid reflux index, body mass index (BMI), Cobb angle, direction of the spinal curve, operative time, blood loss and postoperative outcomes. Results: One hundred one patients underwent laparoscopic fundoplication. Blood loss in patients of ≥18 years of age was significantly higher than that in patients of <18 years of age. A multivariate regression analysis showed that BMI and Cobb angle were significant risk factors. According to the comparison by pediatric surgeons with or without board certification, there were no significant differences in perioperative factors. Conclusion: We focused on BMI and Cobb angle as risk factors for intraoperative blood loss in NIPs during laparoscopic fundoplication.