Laparoscopy in children: physiology and outcome.
Doctoral thesis, UCL (University College London).
Background: Nowadays, in paediatric surgery, intra-abdominal procedures are commonly performed with a laparoscopic approach. Nevertheless, the effects and advantages of laparoscopy in children have not been extensively investigated. Aims of this thesis are: 1) To quantify the absorption of carbon dioxide (C02) during laparoscopy; 2) To investigate if laparoscopy provides benefits compared to open surgery in the management of common surgical conditions in children. Methods: The thesis includes two parts: one part focuses on the absorption of C02 during laparoscopy. The second part focuses on the outcome of laparoscopy. Data were obtained by investigating two common surgical procedures: the Nissen fundoplication for treatment of gastro-oesophageal reflux (GOR) and the Ramstedt pyloromyotomy for treatment of pyloric stenosis. For the laparoscopic Nissen fundoplication, a follow-up study on a randomised controlled trial (RCT) including 38 children was performed. Also, a large review on patients who underwent a second operation (redo-Nissen fundoplication) for recurrent GOR was performed. For the laparoscopic pyloromyotomy, a double blind, multicentre, international, RCT was performed enrolling 180 children. Results: the work in this thesis demonstrates that 10-20% of C02 eliminated during laparoscopy in children is derived from the absorption through the peritoneum. The results of the RCT comparing laparoscopic and open Nissen fundoplication shows that this antireflux procedure improves the quality of life and controls GOR independently of the technique used. The laparoscopic technique is associated with an improvement of gastric emptying in the post-operative period and lower incidence of retching at 4-year follow-up. In children requiring redo-Nissen fundoplication, there is a high failure rate and redo-fundoplication after primary laparoscopic Nissen has lower risk of failure. The RCT comparing laparoscopic with open pyloromyotomy reveals that both procedures are successful. The laparoscopic pyloromyotomy provides a shorter post-operative recovery, lower analgesia requirement and higher parental satisfaction.
|Title:||Laparoscopy in children: physiology and outcome|
|Open access status:||An open access version is available from UCL Discovery|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Child Health|
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