小児の胃食道逆流症に対する腹腔鏡下Boerema-Filler噴門形成術の経験

Clinical experience of laparoscopic Boerema-Filler antireflux procedures in neurologically normal children with gastroesophageal reflux disease

◆要旨：小児の胃食道逆流症（以下，GERD）に腹腔鏡下Boerema-Filler噴門形成術を導入したので報告する．対象はGERD 6例で，年齢は4～68か月，体重は5.4～15.2kg，女児2例，男児4例であった．手術は4ポートで行い食道裂孔を剝離後，腹部食道を確保した．食道裂孔を縫縮し，胃底部を腹部食道左側に縫合した．最後に胃体部前壁を腹壁に前方固定した．手術時間は200～645分で，出血量は6例中5例で少量であったが，1例は癒着の剝離時に出血し100mlであった．開腹移行は認めず，周術期に合併症は認めなかった．術後観察期間は30か月（中央値）で，全例に症状の改善を認めている．小児のGERDに対する外科療法として本法は有用な選択枝と考える．

　The aim of this study was to evaluate clinical experience of laparoscopic modified Boerema-Filler fundoplication in neurologically normal children with gastroesophageal reflux disease（GERD）.

　This study comprised of 6 pediatric patients with mean age of 19-months. Body weight ranged from 5.4 to 15.2 kg and 4 children were boys.

　Laparoscopic Boerema-Filler fundoplication was performed with the 4 port technique. After the intraabdominal esophagus was secured with blunt dissection, crural repair was performed. The upper stomach was secured at the left side of the intraabdominal esophagus, and gastric anteriopexy was performed with the assistance of gastro fiberscopy.

　Mean operative time was 330 minutes, and blood loss was negligible except one case with a large hiatus hernia. Early postoperative dysphagia was not observed in any case, and all patients were discharged within 21 postoperative days. Postoperative mean follow up period was 30 months, and all cases improved their symptoms.

　In conclusion, laparoscopic modified Boerema-Filler fundoplication can be safely performed, and could be an effective alternative. However, further evaluations are required to establish this procedure as a standard operation for neurologically normal children who suffered for GERD related symptoms.