O0020 EFFICACY OF LAPAROSCOPIC ANTIREFLUX PROCEDURES IN THE MANAGEMENT OF GASTROESOPHAGEAL REFLUX FOLLOWING ESOPHAGEAL ATRESIA REPAIR
Bibliographic record
Abstract
Introduction: Gastroesophageal reflux (GER) is a major cause of complications after esophageal atresia repair. The validity of the results of open fundoplications in these patients is still disputed. Methods: From 1998 to 2002, 350 children underwent LARP.Twenty-one/350 patients (6%) were operated at birth for esophageal atresia repair. Our study focused only on the management of these 21 patients.Their age ranged from 6 months to 8 yrs. Five of them (23.8%) were neurologically impaired children (NIC). The indication for surgey were GER and aspirations in all; in addition 5 patients presented severe esophagitis with peptic stricture (23.8%)and other 5 (23.8%) feeding problems. One child had a VACTERL syndrome. All patients had already been treated with proton pump inhibitors without appreciable results. All patients underwent antireflux procedures using laparoscopy: 9 pts (42.8%) according to Nissen; 9 (42.8%) according to Thal and 3 (14.4%) according to Toupet. The 5 NIC with feeding problems underwent concomitant g-tube placement. Results: Hospital stay varied from 2 to 9 days.Follow-up varied between 12 months and 6 yrs.All patients were evaluated with a 24-hours Ph-metry and barium swallow. The 16/21 neurologically normal children are free of symptoms without need for medical therapy. Five/16 (31.2%) of them presented mild dysphagia that disappeared spontaneously within 3–6 months. As for the 5 NIC: one patient eats only through a g-tube, the other four undergo mixed feeding; none have signs of GER, but two of them still present respiratory symptoms, and one has a delayed gastric emptying. Conclusion: Laparoscopic antireflux surgery after esophageal atresia repair is an effective procedure to perform. In our experience the three procedures adopted (Nissen, Thal, Toupet) seem to give comparable results in expert hands; 31.2 % of short term dysphagia can be due to a primary dismotility of the esophagus consequent to the esophageal atresia. Considering that over 20 % of patients presented severe esophagitis with peptic stenosis at the moment of the operation, the indication for surgery could perhaps be anticipated to avoid the complications deriving from the prolonged period on medical therapy. In conclusion, laparoscopic antireflux procedures in patient with GER operated at birth for esopahgeal atresia,in our series seem to give better results compared to those reported in the international literature using open surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".