Conservative treatment is generally sufficient for the majority of children with gastroesophageal reflux or severe feeding problems. However, in a few children antireflux surgery or placement of a feeding tube may be necessary. There are few reports on caregivers’ assessment of outcome of these procedures. Furthermore, it is debated whether children with gastroesophageal reflux have delayed gastric emptying. Lastly, randomized studies comparing open and laparoscopic surgery in children are nearly absent. This was the background for the clinical studies performed in this thesis in Pediatric Surgery.
The aims of the thesis were to report parental evaluation of outcome following fundoplication and placement of a feeding tube, to evaluate gastric emptying using scintigraphy in children with and without gastroesophageal reflux, and to compare complications and length of hospital stay in a randomized study of laparoscopic and open fundoplication.
Parental satisfaction was high following fundoplication and placement of a feeding tube. More than 90% of the parents reported improved well-being of their child after surgery. Laparoscopic fundoplication was found to be a safe alternative to open surgery, but no difference in length of hospital stay or complication rate could be found. Gastric emptying rate was not different between children with gastroesophageal reflux and healthy children.
List of papers. The papers are removed from the thesis due to publisher restrictions.
I. Åvitsland TL, Kristensen C, Emblem R, Veenstra M, Mala T, Bjørnland K. Percutaneous endoscopic gastrostomy in children: A safe technique with major symptom relief and high parental satisfaction. J Pediatr Gastroenterol Nutr 2006;43(5):624-628 DOI: 10.1097/01.mpg.0000229550.54455.63
II. Kristensen C, Åvitsland T, Emblem R, Refsum S, Bjørnland K. Satisfactory long-term results after Nissen fundoplication. Acta Paediatrica 2007; 96(5):702-705 DOI:10.1111/j.1651-2227.2007.00282.x
III. Knatten CK, Fyhn TJ, Edwin B, Schistad O, Emblem R, Bjørnland K. 30-days outcome in children randomized to open and laparoscopic Nissen fundoplication. J Ped Surg 2012;47(11):1990-6 DOI: 10.1016/j.jpedsurg.2012.05.038
IV. Knatten CK, Åvitsland TL, Medhus AW, Fjeld JG, Pripp AH, Emblem R, Bjørnland K. Gastric emptying in healthy children and in children with gastroesophageal reflux. (In press: J Ped Surg). DOI: 10.1016/j.jpedsurg.2013.03.076