• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제9권1호
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• pp.103-107
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• 2006

Belsey Mark IV 위바닥주름술은 이전의 역류 방지 수술이 실패하여 재수술을 해야 하는 경우 혹은 식도 열공 탈장이 오래 되어 유착이 있는 경우에 적응증이 된다. 본 증례는 식도 열공 탈장과 GERD로 진단되어 Nissen 위바닥 주름술을 시행하였으나 실패하였고 재수술을 시도하였지만 수술 부위의 유착이 심하여 수술적 접근이 불가능하였다. 저자들은 흉강을 통하여 Belsey Mark IV 위바닥주름술을 실시하였고, 수술 후 증상과 영양상태의 호전을 보인 1예를 문헌 고찰과 함께 보고하는 바이다.

• Advances in pediatric surgery
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• 제18권2호
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• pp.59-67
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• 2012

Fundoplication is a common surgical procedure for gastroesophageal reflux Disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to compare laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF) for GERD in children. We studied retrospectively the 88 pediatric patients who underwent the Nissen fundoplication for GERD as primary antireflux surgery from 1994 and 2009. ONF was performed in 34 cases and LNF was in 54 cases. 58 patients have neurologic impairment. Time to initial food intake after the surgery were reduced in the LNF group (p= 0.032). Recurrent GERD symptom occurred in one patient in LNF group and four patients in ONF group within 1 year after the surgery (p= 0.012). There were no statistically significant differences in post operative morbidity and mortality between both groups. In conclusion, our practice of Nissen fundoplication indicates that LNF takes priority in most pediatric patients.

• Journal of Chest Surgery
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• 제39권9호
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• pp.733-738
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• 2006

위식도역류질환은 서구에선 매우 유병률이 높으며 우리나라에서도 식생활의 서구화로 인해 유병률이 증가하고 있다. 최근 최소침습수술이 발달함에 따라 복강경을 이용하여 수술할 경우 미용효과, 단기재원기간 및 일상생활로의 조기복귀 등의 장점이 있어 장기적인 약물치료보다는 최소침습법에 의한 수술의 시행이 늘어날 것으로 예상된다. 저자들은 복강경을 이용하여 횡격막 탈장 및 탈장을 동반한 위식도역류성 질환에 대해 시행한 니센 위저추벽성형술 및 콜리스 위성형술 치험을 바탕으로 수술수기를 중심으로 문헌고찰과 함께 보고하는 바이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권1호
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• pp.92-98
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• 2001

덤핑증후군은 소아에서 위식도역류의 치료로 위저추벽성형술을 시행하는 경우에 잘 발생하는 질환으로 당 부하 검사를 통하여 식사 직후에 나타나는 고혈당과 뒤이어 나타나는 저혈당을 보임으로써 진단될 수 있으며, 생 옥수수 전분을 포함한 식이 요법으로 효과적으로 치료될 수 있다. 저자들은 위저추벽성형술을 시행 받은 뒤에 덤핑증후군이 발생한 1례를 경험하였고, 본 질환이 소아에서 위저추벽성형술과 같은 위 수술 후에 수유장애가 있을 경우 반드시 의심해보아야 할 질환이라고 사료되어 문헌 고찰과 함께 보고하는 바이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권2호
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• pp.93-97
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• 2014

Purpose: Gastroesophageal reflux in infant is a physiological process. However, surgery is performed in high risk infants with severe gastroesophageal reflux disease (GERD) when medical management fails. This study focuses on efficacy and safety of Nissen fundoplication for GERD in infants under age 12 months. Methods: This study was a retrospective case analysis of 11 neonates and infants under 12 months of age who underwent Nissen fundoplication following a failure of medical treatment between June 2010 and June 2013 at Pusan National University Children's Hospital. The records were reviewed to determine the effect of fundoplication on symptoms and post-operative complications. Results: A total of 11 infants consist of four males and seven females. Mean birth weight was $2,305.5{\pm}558.6g$ (1,390-3,130 g). They had some underlying disease, which are not related with GERD such as congenital heart disease (54.5%), prematurity (45.5%), neurologic disease (18.2%), respiratory disease (18.2%), and other gastrointestinal disease. Mean body weight at surgery was $3,803.6{\pm}1,864.9g$ (1,938.7-5,668.5 g). Mean age at operation was $99.9{\pm}107.6days$ (17-276 days). Duration from operation to full enteral feeding was 10.9 days. Symptoms related GERD disappeared in all patients including one who got reoperation. One infant died of congenital heart disease unrelated to surgery. There were no complications related to fundoplication. Conclusion: Fundoplication is effective and safe treatment in the neonates and infants with severe GERD.

• Advances in pediatric surgery
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• 제13권1호
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• pp.13-22
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• 2007

Fundoplication is accepted as an effective treatment of gastroesophageal reflux disease. The recent results of laparoscopic fundoplication demonstrated safety and less morbidity, shorter hospital stay and less pulmonary complication compared to the open operation. Laparoscopic fundoplication has been our first choice of operation for gastroesophageal reflux disease since 2003. Among 29 cases, there were 2 conversion cases because of severe distension of transverse colon and hepatomegaly. We studied 27 consecutive patients operated upon from January 2003 through December 2004. There were 15 boys and 12 girls, ages from 1.5 months to 12 years (median 25.3 months). Body weight ranged from 2.9 kg to 37 kg (median 9.8 kg). Neurological abnormalities were present in 23 patients. Indications for surgery included medically refractory reflux associated with vomiting, pneumopathy, otorhinolaryngologic pathology, failure to thrive, esophagitis, apnea and bradycardia. We used 4-5 trocars of 5 mm or 12 mm with $30^{\circ}$ telescope and performed the Nissen technique in all patients. In neurological impaired patients, gastrostomy tube was placed at the time of fundoplication. Median operative time was 130 minutes (70 - 300 minutes). There was no mortality nor intraoperative complication. Twenty-six patients were followed for median of 19 months (8 - 31 months). Four patients (15.4 %), who were all neurological impaired, developed recurrent symptoms of gastroesophageal reflux disease. Two of these patients had reoperation (1 laparoscopic approach, 1 open method). There were significant increases in body weight in 11 patients after fundoplication. Laparoscopic fundoplication is acceptable as a safe and effective method for gastroesophageal reflux disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권1호
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• pp.34-40
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• 2017

Purpose: This study was performed to review the outcomes of gastrostomy insertion in children at our institute during 10 years. Methods: A retrospective chart review was performed on 236 patients who underwent gastrostomy insertion from October 2005 to March 2015. We used our algorithm to select the least invasive method for gastrostomy insertion for each patient. Long-term follow-up was performed to analyze complications related to the method of gastrostomy insertion. Results: Out of 236 patients, 120 underwent endoscopic gastrostomy, 79 had laparoscopic gastrostomy, and 37 had open gastrostomy procedures. The total major complication rates for endoscopic gastrostomy insertion, laparoscopic gastrostomy insertion, and open gastrostomy were 9.2%, 8.9%, and 8.1%, respectively. The most common major complication was gastroesophageal reflux requiring Nissen fundoplication (3.8%), and other complications included peritonitis (1.3%), hiatal hernia (1.3%), and bowel perforation (0.8%). Gastrostomy removal was successful in 8.6% and 5.0% of patients in the endoscopic and surgical gastrostomy groups, respectively. Gastrocutaneous fistula occurred in 60% of surgically inserted cases, requiring a second operation. Conclusion: This retrospective study was performed to review the outcome of gastrostomy insertion, as well as to introduce an algorithm that can be used for future cases. Further studies should be conducted to make a consensus on choosing the most appropriate method for gastrostomy insertion.