Pediatric Laparoscopic Surgery Anti-reflux Surgery

As the name of the disorder implies, Gastro-esophageal reflux disease (GERD) is the reflux of stomach contents and acid into the lower part of the esophagus. This acid makes up the vast majority of the contents of the stomach and "burns" or damages the esophagus because, unlike the stomach, it has no protective lining to guard the tissue from corrosive stomach acid. The burning often radiates throughout the breast or thoracic region.

The most basic cause of GERD or acid reflux is a failure or break down of the valve that we all have between our esophagus and our stomach which typically keeps stomach contents from traveling back up. Other symptoms in advanced cases include acid regurgitation, vomiting and choking attacks, chronic cough and a difficult in swallowing. Many of the symptoms can be frequent at night, primarily because of the position (lying down).

Surgery

When other treatments fail to produce results or alleviate symptoms, pediatric laparoscopic surgery is performed. In many cases, families may opt to have corrective pediatric surgery rather than have their child on medication for the rest of their lives.

Medication Therapy

Therapy and treatment using medications is often very successful at alleviating symptoms and controlling acid reflux in patients. These medications, known as proton pump inhibitors, dramatically reduce the gastric acid production in the body. Unfortunately, once a patient is taking these medications they must remain on them for the duration of their life unless parents opt for pediatric surgery to correct the malfunctioning valve.

Lifestyle Changes

Some lifestyle changes could help improve symptoms in children. For pediatric patients, the primary concern would be the diet as well as dangerous weight gain in young children. Correcting these issues could reduce symptoms to a manageable level.

In pediatric laparoscopic surgery, surgeons create several small incisions in the abdomen. Small cannulae or ports are inserted. Through the ports, surgeons insert a small camera which magnifies the inside view of the body. Fine instruments are inserted through the other incisions and the abdominal cavity is inflated with gas, allowing the surgeon more room to work.

During this particular procedure, the upper portion of the stomach known as the gastric fundus is wrapped around the lower end of the esophagus and then stitched into place. This reinforces the closing function of the valve or lower esophageal sphincter

Minimally invasive surgical procedures like pediatric laparoscopic surgery are not new. While it's difficult to credit a single individual with the invention of the procedure, it can be traced back to a long history in western medicine. In 1902, Georg Kelling of Dresden, Saxony performed the first laparoscopic procedure on a canine. In 1910, Hans Christian Jacobaeus of Sweden reported on the first laparoscopic procedure to be performed on humans.

Today, there are still a limited number of facilities capable of performing a wide range of procedures using minimally invasive surgery. Steven and Alexandra Cohen Children's Medical Center of New York is the only medical center servicing New York, New Jersey and Connecticut capable of providing laparoscopic surgery for more than a dozen procedures.

Pediatric laparoscopic surgery to reduce the symptoms and discomfort of GERD is widely accepted because of its success rate. In addition, patients experience far less discomfort and pain during post-operative recovery. Most feel some discomfort for one to two days. This is due to the relatively small incisions when compared to the large open incisions previously used that required long hospital stays.

Thanks to this minimally invasive surgery, children can often return to a normal, healthy and active lifestyle within 2 to 4 weeks.

While this is a minimally invasive procedure and complications are greatly reduced over past forms of open surgery, there remains some risk of complication. This can include:

Bleeding

Infection Complications associated with anesthesia

Injury to surrounding tissues

Despite the risks, pediatric laparoscopic surgery for relieving acid-reflux is considered to be safe and effective, with a mortality rate of less than 1%. Research has shown that after 10 years, nearly 90% of patients remain symptom-free.