scholarly journals Laparoscopic Watson Fundoplication Is Effective and Durable in Children with Gastrooesophageal Reflux

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Matthew G. Dunckley ◽  
Kapil M. Rajwani ◽  
Anies A. Mahomed
Keyword(s):  
Neurological Impairment ◽  
Paediatric Population ◽  
Reoperation Rate ◽  
Antireflux Procedure ◽  
Partial Fundoplication ◽  
Paediatric Surgery ◽  
Mechanical Complications ◽  
Anterior Fundoplication ◽  
Gastrooesophageal Reflux ◽  
Risk Of Aspiration

Gastroesophageal reflux (GOR) affects 2–8% of children over 3 years of age and is associated with significant morbidity. The disorder is particularly critical in neurologically impaired children, who have a high risk of aspiration. Traditionally, the surgical antireflux procedure of choice has been Nissen’s operation. However, this technique has a significant incidence of mechanical complications and has a reoperation rate of approximately 7%, leading to the development of alternative approaches. Watson’s technique of partial anterior fundoplication has been shown to achieve long-lasting reflux control in adults with few mechanical complications, but there is limited data in the paediatric population. We present here short- and long-term outcomes of laparoscopic Watson fundoplication in a series of 76 children and infants, 34% of whom had a degree of neurological impairment including severe cerebral palsy and hypoxic brain injury. The overall complication rate was 27.6%, of which only 1 was classified as major. To date, we have not recorded any incidences of perforation and no revisions. In our experience, Watson’s laparoscopic partial fundoplication can be performed with minimal complications and with durable results, not least in neurologically compromised children, making it a viable alternative to the Nissen procedure in paediatric surgery.

scholarly journals Caudal tramadol bupivacaine combination for postoperative pain releif in subumbilical paediatric surgery

2014 ◽  
Vol 23 (2) ◽  
pp. 42-46
Author(s):  
Md Shafiqul Islam ◽  
Md Tajul Islam ◽  
Dilip Kumar Bhowmick ◽  
Moinul Hossain ◽  
AKM Akhtaruzzaman ◽  
...  
Keyword(s):  
Postoperative Nausea And Vomiting ◽  
Paediatric Population ◽  
Paediatric Surgery ◽  
Physical Status ◽  
Anaesthetic Agents ◽  
Group I ◽  
Caudal Analgesia ◽  
Group Ii ◽  
To Receive ◽  
Control Study

Background Regional anaesthesia in children provides the advantage of reduced requirements of other anaesthetic agents and of excellent analgesia introduction. Rational use of adjuvant with local anaesthetic in caudal route for prolonged optimal analgesia in paediatric population. Objectives To evaluate the quality and duration of postoperative analgesia in children undergoing subumbilical surgeries with caudally administered mixture of tramadol and bupivacaine. Methods Sixty children of ASA physical status I & II scheduled for elective subumbilical surgery were included in this prospective case-control study. Children were randomly assigned to receive caudal analgesia with plain bupivacaine (Group-I) and a mixture of tramadol-bupivacaine (Group-II) respectively. Blood pressure, heart rate, oxygen saturation and duration of analgesia were recorded postoperatively. Results Study revealed that mean duration of caudal analgesia in Group-I and Group-II were 245.67 ± 6.94 and 612.05 ± 16.49 minutes respectively which was significantly longer (P<0.001) in Group-II. Mean number of postoperative analgesics were 2.97±0.50 and 1.78±0.50 in Group-I and Group-II which was statistically highly significant (P=0.000). Postoperative nausea and vomiting was significantly high in Group-II (P=0.019). Conclusion Combination of tramadol with bupivacaine results in prolonged analgesia when administered in caudal route. In addition, tramadol is more useful in young children considering less respiratory depression than other opioids. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18172 Journal of BSA, 2009; 23(2): 42-46

Heller Myotomy: To Wrap or Not to Wrap?

2018 ◽  
Vol 84 (6) ◽  
pp. 1022-1026
Author(s):  
Jordan Brown ◽  
Michael Egger ◽  
Farid J. Kehdy
Keyword(s):  
Effective Treatment ◽  
Heller Myotomy ◽  
Postoperative Outcomes ◽  
Antireflux Procedure ◽  
Partial Fundoplication ◽  
Esophageal Reflux ◽  
Postoperative Dysphagia ◽  
Reflux Symptoms ◽  
Postoperative Reflux ◽  
Mcnemar’S Test

Heller myotomy (HM) is widely recognized as the most effective treatment of achalasia. Although effective in improving dysphagia symptoms, HM is associated with reflux. Over a five-year period, 63 laparoscopic HM were performed. Patients underwent myotomy alone or HM plus reconstitution of the angle of His without any fundoplication, anterior, or posterior partial fundoplication. Two postoperative outcomes were examined: dysphagia and reflux. Twenty-two patients received no fundoplication (34.9%). Forty-one (65.1%) antireflux procedures were performed, including 21 reconstitutions of the angle of His (33.3%), nine (14.3%) anterior fundoplications, and 11 (17.5%) posterior fundoplications. All patients demonstrated preoperative dysphagia. Postoperative dysphagia was present in 23 of 63 (36.5%). Of these, 13 (56.5%) patients had an antireflux procedure, whereas 28 of 40 who had an antireflux procedure (70%) had no postoperative dysphagia (P = 0.28). Thirty-nine of 62 (62.9%) had symptomatic esophageal reflux preoperatively, and postoperative reflux was reported in 22 of 63 (34.9%). Reflux was present in 72.7 per cent of patients who had an antireflux procedure versus 61 per cent of those without the addition of an antireflux procedure (P = 0.415). However, HM independently improved reflux status regardless of whether an antireflux procedure was performed using the exact McNemar's test (P = 0.0014). Although the performance of an antireflux procedure did not appear to alter the reflux status after HM for achalasia, neither was it associated with postoperative dysphagia. More importantly, HM was independently associated with an improvement of reflux symptoms regardless of the type of antireflux procedure performed or whether one was used or not.

Long-Term Outcomes of POEM for Primary Esophageal Motility Disorders

2021 ◽  
Author(s):  
Christine Tat ◽  
Matthew Kroh
Keyword(s):  
Esophageal Motility ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Laparoscopic Heller Myotomy ◽  
Esophageal Motility Disorders ◽  
Antireflux Procedure ◽  
Partial Fundoplication ◽  
Motility Disorders ◽  
Primary Esophageal Motility Disorders

AbstractSince peroral endoscopic myotomy (POEM) emerged in 2010 as a treatment for achalasia, more than 7,000 procedures have been performed in the world. The main indication for POEM continues to be achalasia, which is a rare esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and aperistalsis. POEM has also been applied in other types of primary esophageal motility disorders. Short-term outcomes indicate that POEM has comparable results to laparoscopic Heller myotomy in terms of efficacy and safety. Studies show decrease in Eckardt scores after POEM as a reflection of symptomatic relief. Now, a decade after its introduction, long-term data have emerged for POEM and demonstrates that POEM remains effective and safe. Both POEM and laparoscopic Heller myotomy are associated with postinterventional gastroesophageal reflux disease (GERD). Antireflux mechanisms are disrupted during the procedures. However, the rate of GERD is higher after POEM than with laparoscopic Heller myotomy. Laparoscopic Heller myotomy is commonly performed with a partial fundoplication to reduce antireflux, but POEM is not typically combined with an antireflux procedure. Further studies should examine the long-term effects of postinterventional GERD.

scholarly journals Long-Term Follow-up Results of Children Undergoing Achalasia Surgery

2021 ◽  
Author(s):  
Kutay Bahadır ◽  
Ergun Ergun ◽  
Anar Jafarov ◽  
Merve Bülbül ◽  
Gülnur Göllü ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Antireflux Procedure ◽  
Partial Fundoplication ◽  
Withdrawal Time ◽  
Average Hospital ◽  
Gold Standard Method ◽  
Study Results ◽  
Long Term Follow Up ◽  
The One

Objective: Achalasia is a disease characterized by lower esophageal sphincter motility disorder. Whereas there is no clear algorithm in treating achalasia in children, Heller myotomy is known to be as the most effective method. Gastroesophageal reflux after myotomy is a frequently reported complication. Therefore, the fundoplication procedure should be added to the myotomy simultaneously. Our study aimed to present the results of patients who underwent Heller myotomy and fundoplication for achalasia. Materails and Methods: Twelve patients who underwent laparoscopic Heller myotomy with the diagnosis of achalasia between the 2006 and 2019 have been included in the study. Results: There were 12 children. 75% of them were male, and 25% were female. Laparoscopic Heller myotomy and antireflux procedure were applied to all patients. The average nasogastric withdrawal time was 1.75 days, the average time to start feeding was 2.25 days. The average hospital stay was 6.75 days. Dysphagia persisted in 3 patients who underwent Dor fundoplication and in 1 patient who underwent Toupet fundoplication at postoperative 3rd-week controls. It was observed that the symptoms improved after the one-time endoscopic dilatation procedure. Conclusion: Heller myotomy is gold standard method in the treatment of achalasia in children.We believe that partial fundoplication added to myotomy reduces the risk of GER.

scholarly journals 786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Huang ◽  
E Bhargava ◽  
M Walsh ◽  
D Pennell ◽  
H Attya ◽  
...  
Keyword(s):  
Universal Screening ◽  
Surgical Complication ◽  
Paediatric Population ◽  
Medical Complications ◽  
High Morbidity ◽  
Paediatric Surgery ◽  
Infection Rates ◽  
Ent Surgery ◽  
Surgery Outcomes ◽  
Lower Morbidity

Abstract Introduction Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A &lt; 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population. Method Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020. Results 61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID. Conclusions Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.

Anterior fundoplication (Dor) after myotomy for achalasia: The antireflux procedure of choice based on ease of performance and clinical results

2000 ◽  
Vol 118 (4) ◽  
pp. A1510 ◽  
Author(s):  
Philip E. Donahue ◽  
Katherine J-M Liu ◽  
Paul K. Schlesinger ◽  
Harry M. Richter ◽  
Bashar M. Attar
Keyword(s):  
Clinical Results ◽  
Antireflux Procedure ◽  
Anterior Fundoplication

scholarly journals Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

2020 ◽  
Vol 34 (4) ◽  
pp. 70-75
Author(s):  
Mukhtiar Ahmed ◽  
Jamil Akhter Munir Ahmad ◽  
Muhammad Ali Sheikh ◽  
Tariq Latif ◽  
Abdul Qayyum
Keyword(s):  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Symptomatic Relief ◽  
Paediatric Population ◽  
Paediatric Surgery ◽  
Exact Etiology ◽  
Group A ◽  
Bleeding Per Rectum ◽  
Group B

Introduction: Anal fissure is a common problem in children, the exact etiology of which is unknown and it mostly presents with painful defecation and bleeding per rectum. The standard treatment of anal fissure is lateral internal sphincterotomy but due to risk of fecal incontinence chemical sphincterotomy is used as alternative to surgical sphincterotomy. Aims & Objectives: To compare the effectiveness of topical diltiazem and lignocaine with glyceryl trinitrate and lignocaine in relieving of symptoms and healing of acute anal fissure in children. Place and duration of study: This study was conducted in the Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore & Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material & Methods: Total 228 children were enrolled in the study and randomly divided in group A and B, 114 children in each group. Group A received topical 2% diltiazem cream and 2% lignocaine gel, while group B received topical 0.2% glyceryl trinitrate and 2% lignocaine gel, applied locally, twice daily. Results: There were 78(68.4%) male children in group A and 66(57.9%) in group B. All patients completed 6 week treatment course. The symptoms and condition of the anal fissure were evaluated before start of treatment and at subsequent follow up periods. In group A 55 (48.2%) cases completely healed by second week, while in group B, 33 (28.9%) cases healed. The number of completely healed cases at 4 weeks follow up in group A and group B were 91 (79.8%) and 69(60.5%) respectively, while at week 6 follow up this rate was 95 (83.3%) and 73 (64.0%) respectively. Symptomatic relief in painful defecation observed in group A and group B was 74(64.9%) and 55(48.2%) at week 2, 95(83.3%) and 74(64.9%) at week 4 while 95(83.3%) and 77(67.5%) at week 6 in two groups respectively. Conclusion: Use of combination of topical diltiazem and lignocaine for the treatment of acute anal fissure in paediatric population is preferred over combination of glyceryl trinitrate and lignocaine.

scholarly journals Perioperative manometric studies in laparoscopic Watson’s repair versus Nissen’s fundoplication

2018 ◽  
Vol 6 (1) ◽  
pp. 244
Author(s):  
Moharam Abdelshahid ◽  
Mohammed Sabry Ammar ◽  
Mohammed Nazeeh SH. Nassar
Keyword(s):  
Hiatus Hernia ◽  
Surgical Techniques ◽  
Partial Fundoplication ◽  
Reflux Symptoms ◽  
Anterior Fundoplication ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Partial Anterior Fundoplication

Background: Hiatus Hernia (HH) and GERD are common upper gastroesophageal disorders, The Nissen`s fundoplication is one of the most effective and commonly used surgical techniques in management of both GERD and hiatus hernia (HH). many surgeons are searching for alternative procedures due to the mechanical obstructive effects of Nissen's fundoplication, one of these procedures is partial anterior fundoplication (Watson’s repair).Methods: Eighty two patients, diagnosed to have GERD and/or HH, were scheduled for present study for laparoscopic anti-reflux surgery. They were randomized to either Watson’s repair (anterior partial fundoplication) (group I) or Nissen repair (group II) in the period between June 2012 and March 2017. Forty two patients for group I and forty patients were included in group II. Group I had partial anterior fundoplication and group II had Nissen's fundoplication. Follow up for all patients included in our study was scheduled at (2, 4weeks and 3, 6, 12months postoperatively) both subjectively - using a standardized scoring system for reflux symptoms (heartburn, regurgitation and dysphagia), gas bloating and objectively-using esophago-gastroscopy at 6ms and 12ms postoperatively, esophageal manometry, 24hours PH monitoring at 6ms and 12ms post operatively.Results: Three cases were excluded from the study because they were converted to open procedure, one of group I and two of group II. Mean operative time was significantly shorter in group I. As regarding to reflux symptoms (heartburn and regurgitation) Nissen was significantly higher in control of reflux symptoms at 3months but at 6, 12months Nissen still higher but without a clear significant difference. On the opposite side dysphagia was significantly higher in Nissen group than in Watson group at 3months and remained higher at 6,12months but with no significant difference, also gas related symptoms were higher in Nissen group than in Watson group all the time of follow up. Objectively, esophagitis improved to a similar extent in both groups. Watson was less effective in improving LES characters, and 24hours PH parameters in comparison to Nissen group but without any significant difference in both groups.Conclusions: Partial anterior fundoplication (Watson repair) can be safe, effective and simple alternative procedure for Nissen's fundoplication with less obstructive symptoms and complications.

Treatment of Unstable Trochanteric / Subtrocanteric Fractures with PFN, First Cases in University Hospital of Trauma & American Hospital. Results and Complications.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Ledian Fezollari ◽  
Gjergj Caushi ◽  
Vilson Ruci ◽  
Artid Duni ◽  
Agron Dogjani ◽  
...  
Keyword(s):  
Femoral Fractures ◽  
Operation Time ◽  
Reoperation Rate ◽  
Proximal Femoral Fracture ◽  
Minimal Invasive ◽  
University Hospital ◽  
Harris Hip Score ◽  
Proximal Femoral Fractures ◽  
American Hospital ◽  
Mechanical Complications

Aims and objectives: This study was done to evaluate the functional and radiographic outcome of PFN in treatment of proximal femoral fracture and more common technical, mechanical complications and intraoperative difficulties during the implant implementation. Materials & Methods: We conducted a retrospective study with ten cases of proximal femoral fractures treated between September 2017 and September 2018, which were accepted at the Department of Orthopedics, the University Hospital of Trauma and the American Hospital in Tirana. Fractures are classified according to classification AO and Boyd-Griffin. The age range of patients taking the study was 20-90 years. Ten cases were followed at regular intervals and the final assessment was made at the end of the 6 month period. In the result, functional clinical assessment according to Harris hip score was done . Results: In our study,mean age was 66 y.o, 7 male and 3 females. Mean of hospitalization time 6 days, mean operation time 120 min. In our study at 6 months follow up, union was achieved in 9 cases, open reduction was performed in 3 cases (10 cases). Technical and mechanical complications were noted in one case. Reoperation rate was 10 % (one case). According Harris hip scoring system excellent results were seen 40   % of cases (4 cases), good results in 50 % cases (5 cases),  and poor results in 10% cases (1 case). Conclusions: In our study, in spite of low experience in proximal femoral nailing in cases with unstable trochanteric / subtrocanteric fractures, it was found that PFN is an attractive implant and suitable for proximal femoral fractures and its use in unstable trochanteric / subtrocanteric fractures is very encouraging. This study has also shown that this device can safely be used by an average surgeon to handle common but sometimes tough fractures. Operation is technically not difficult, but gradual learning and great patience is needed to make this method really minimal invasive.

195 RANDOMISED TRIAL OF LAPAROSCOPIC NISSEN VS. ANTERIOR 180 DEGREE PARTIAL FUNDOPLICATION—LATE CLINICAL OUTCOMES AT 15–20 YEARS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
V Rudolph-Stringer ◽  
T Bright ◽  
P Devitt ◽  
P Game ◽  
G Jamieson ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Outcomes ◽  
Nissen Fundoplication ◽  
Symptom Control ◽  
Randomised Trial ◽  
Randomised Control Trial ◽  
Partial Fundoplication ◽  
Anterior Fundoplication ◽  
Laparoscopic Nissen

Abstract   Laparoscopic Nissen fundoplication for gastro-oesophageal reflux is followed by troublesome side effects in some patients. Partial fundoplications are proposed for reflux control with less side effects. We reported earlier outcomes from a randomised control trial of Nissen vs. anterior 180° partial fundoplication, with a good outcome following anterior 180° partial fundoplication at up to 10 years follow-up. For this study we determined very late clinical outcomes at up to 20 years follow-up. Methods 107 patients were randomised to Nissen vs. anterior 180° partial fundoplication. 15–20 year follow-up data was available for 79 (41 Nissen, 38 anterior). Outcome was assessed using a standardised clinical questionnaire that included 0–10 analogue scores and yes/no questions to evaluate reflux symptoms, side-effects and overall satisfaction with surgery. Results Heartburn (mean score 3.2 vs 1.4, p = 0.001) and proton pump inhibitor use (41.7% vs 17.1%, p = 0.023) were higher, dysphagia for solids (mean score 1.8 vs 3.3, p = 0.015) was less, and ability to belch was better preserved (84.2% vs 65.9%, p = 0.030) after anterior fundoplication. Overall outcome measures were similar for both groups (mean satisfaction score 8.4 vs 8.0, p = 0.444; 86.8% vs 90.2% satisfied with outcome). Six patients underwent revision from anterior to Nissen fundoplication for reflux, and 5 from Nissen to partial fundoplication for dysphagia. Two further patients underwent revision following Nissen fundoplication for reflux and paraoesophageal hernia respectively. Conclusion At up to 20 years follow-up Nissen and anterior 180-degree partial fundoplication achieve similar rates over overall success, but with a demonstrable trade-off between better reflux symptom control vs. more side-effects after Nissen fundoplication.

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