Risk Factors for Recurrence of Gastroesophageal Reflux Disease After Laparoscopic Nissen Fundoplication in Patients With Severe Motor and Intellectual Disabilities

Abstract

Purpose

Laparoscopic Nissen fundoplication (LNF) is the standard surgical treatment for gastroesophageal reflux disease (GERD) in patients with severe motor and intellectual disabilities (SMID). It is necessary to prevent the recurrence of GERD because it poses multiple clinical and surgical challenges for these patients. In Japan, the Endoscopic Surgical Skill Qualification System (ESSQS) has been established to ensure technical competency in laparoscopic surgery for pediatric patients. Our aim was to elucidate the risk factors for recurrence of GERD after LNF in pediatric patients with SMID.

Methods

Fifty patients with SMID who underwent LNF with gastrostomy for GERD at our institution between January 2009 and April 2022 were retrospectively investigated. Recurrence rate and risk factors were examined in univariate and multivariate analyses.

Results

GERD recurred in 5 of the 50 patients (10.0%). In univariate analysis, operation time was significantly longer in the recurrence group than in the non-recurrence group (333 vs. 254 min, p = 0.01). No operations in the recurrence group were performed by an ESSQS-qualified surgeon (p = 0.28). In multivariate analysis, operation time was an independent risk factor for recurrence.

Conclusion

Operation time was identified as a risk factor for recurrence of GERD after LNF in patients with SMID.

Evidence

II.