If you don't have transmigration as a problem in your practice, I wouldn't change anything, but in our practices in Birmingham and in Kansas City, it seemed like transmigration was the 90% of the reasons why we were having to redo them, and that's really what led to this study is trying to find a way to reduce transmigration and minimal mobilization, uh, seems to do that.
RCT of laparoscopic versus open fundoplication in children under age 2 (21 open, 18 laparoscopic over 7 years) showed no difference in length of stay, time to full feeds, or analgesic requirements, but laparoscopic had longer operative time and higher surgical charges
host_summaryGastroesophageal reflux occurs in more than two-thirds of otherwise healthy infants and is discussed at 25% of all 6-month pediatric visits↗
▶Ep 5 · 5:20
host_summary2009 NASPGHAN and ESPGHAN guidelines state surgical approaches should be reserved for children with intractable symptoms unresponsive to medical therapy and those at risk for life-threatening complications of reflux disease↗
▶Ep 5 · 9:43
host_summaryAAP guidelines note H2 antagonists or PPIs may have risk factors for pneumonia, gastroenteritis, candidemia, and NEC in preterm infants↗
▶Ep 5 · 16:52
host_summaryMeta-analysis of 400 fundoplications versus 125 gastrojejunostomy tubes showed no difference in pneumonia rate or mortality, but 29% major complications in fundo group versus lower rate in GJ group, and 70% minor complications in GJ group↗
▶Ep 5 · 18:00
host_summaryRCT of 44 laparoscopic versus 43 open fundoplications showed recurrence of reflux was 37% in laparoscopic group and only 7% in open group, with 5.2% higher risk of recurrence in laparoscopic group↗
▶Ep 5 · 18:00
host_summaryRCT of laparoscopic versus open fundoplication in children under age 2 (21 open, 18 laparoscopic over 7 years) showed no difference in length of stay, time to full feeds, or analgesic requirements, but laparoscopic had longer operative time and higher surgical charges↗
▶Ep 5 · 22:00
host_summaryMeta-analysis showed improved outcomes following complete fundoplication compared to partial wrap, though the difference was barely significant↗
▶Ep 5 · 24:07
clinicalTransmigration was 90% of the reasons for needing to redo fundoplications in Birmingham and Kansas City practices↗
▶Ep 5 · 24:07
quoteIf you don't have transmigration as a problem in your practice, I wouldn't change anything, but in our practices in Birmingham and in Kansas City, it seemed like transmigration was the 90% of the reasons why we were having to redo them, and that's really what led to this study is trying to find a way to reduce transmigration and minimal mobilization, uh, seems to do that.↗
▶Ep 5 · 27:00
host_summaryStudy showed 4% incidence of changes on upper GI prior to G-tube placement, with 80% of that 4% due to malrotation↗
