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Adjudication committee
- First opponent: Professor Helene Engastrand Lilja, Uppsala University, Sweden
- Second opponent: Docent Lars Hagander, Lund University, Sweden
- Third member and chair of the evaluation committee: Professor II Kjersti Flatmark, Institute of Clinical Medicine, University of Oslo
Chair of defence
Professor Knut Lundin, Institute of Clinical Medicine, University of Oslo
Principal supervisor
Professor II Kristin Bjørnland, Institute of Clinical Medicine, University of Oslo
Summary
Gastrostomy insertion and fundoplication are two common surgical procedures used to treat severe feeding problems and gastroesophageal reflux disease in children. In later years, novel techniques using endoscopy and laparoscopy have been introduced, but there are few reports on how this has influenced outcomes.
In the first part of the thesis, retrospective chart reviews were performed to investigate trends in gastrostomy insertion and to report outcomes after introduction of two new techniques: percutaneous endoscopic gastrostomy with T-fastener gastropexy and laparoscopic gastrostomy insertion.
The yearly number of gastrostomy insertions more than doubled during a 20-year period; from 24 in 1994 to 57 in 2012. Furthermore, the demographics of the patients changed. Early, minor postoperative complications were common and occurred in nearly half of the patients. It was also demonstrated that the T-fasteners caused significant troubles in many patients.
In a randomized controlled trial, 85 patients underwent fundoplication with either open or laparoscopic technique. After a follow-up of median 12 years, recurrence was significantly more common after laparoscopy (56 %) than after open fundoplication (31 %). Still, over 80 % of parents and patients were satisfied with the outcomes of the operation. Patients with and without neurologic impairment had similar results after fundoplication, and in both groups, symptoms decreased after surgery and, over 90 % of parents were satisfied with the results.
Some patients with recurrence after fundoplication undergo a redo fundoplication. In a study of 24 patients, based on questionnaires and a retrospective chart review, nearly 80 % were without signs of recurrence after median 9 years most parents were satisfied with the operation.
The findings from these studies show the importance of reviewing results when implementing new techniques.
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