LAPAROSCOPIC GASTRIC ANTROPLASTY IN CHILDREN WITH DELAYED GASTRIC-EMPTYING AND GASTROESOPHAGEAL REFLUX

Background/Purpose: A significant number of children (50%) with gastro esophageal reflux (GER) have delayed gastric emptying (DGE). Although controversial, many pediatric surgeons use a gastric outlet procedure in conjunction with fundoplication for gastroesophageal reflux in thes e patients. This paper describes the technique and clinical outcome of 61 patients undergoing a laparoscopic gastric antroplasty at the time of the laparoscopic fundoplication. Methods: The charts of 61 patient s who underwent laparoscopic gastric antroplasty in conjunction with l aparoscopic fundoplication between May 26, 1992 and October 17, 1996 w ere reviewed retrospectively. All patients had a documented DGE confir med by a liquid isotope meal being retained in the stomach. After comp letion of the fundoplication, a laparoscopic antroplasty was performed by incising a 2 to 3.5-cm linear incision in the pylorus and distal g astric antrum. The seromuscular wall was divided to the level of the m ucosa allowing the mucosa to bulge through the defect. The wound was c losed transversely using interrupted 2-0 silk sutures. Results: Four o f the 61 patients underwent conversion to open antroplasty for technic al reasons. The remaining 57 patients recovered uneventfully from the laparoscopic antroplasty with clinical resolution of both GER and DGE. Two of 57 patients had intermittent episodes of retching and were una ble to tolerate large bolus feedings because of dumping, They were tre ated by dividing the feedings into two smaller portions. These symptom s cleared within 6 months. The remaining 55 patients have tolerated fe edings well. Evaluation of the gastric emptying was performed randomly in selected patients with documented improvement of the emptying afte r antroplasty, An evisceration of omentum through the umbilical incisi on developed in one patient on the third postoperative day. Conclusion s: Patients with delayed gastric emptying who need fundoplication can be treated with laparoscopic gastric antroplasty in conjunction with l aparoscopic fundoplication. Laparoscopic antroplasty appears to be cli nically efficacious in improving delayed gastric emptying. Copyright ( C) 1998 by W. B. Saunders Company.