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Gastric emptying procedures decrease the risk of postoperative recurrent reflux in children with delayed gastric

J Bustorff-Silva1, E W Fonkalsrud, C A Perez

  • 1Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, CA 90095-1749, USA.

Journal of Pediatric Surgery
|February 18, 1999
PubMed
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Adding a gastric emptying procedure (GEP) to fundoplication in children with delayed gastric emptying (DGE) may reduce recurrent gastroesophageal reflux (GER). Children with DGE undergoing fundoplication without GEP had double the rate of recurrent GER.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Outcomes

Background:

  • Gastroesophageal reflux (GER) and delayed gastric emptying (DGE) often require surgical intervention.
  • Nissen fundoplication (NF) is a common surgical treatment for GER.
  • The added benefit of a gastric emptying procedure (GEP) during NF for DGE remains debated.

Purpose of the Study:

  • To evaluate the impact of adding a GEP to NF on the recurrence rate of GER in children with preoperatively diagnosed DGE.
  • To determine if GEP influences GER recurrence after NF in pediatric patients.

Main Methods:

  • Retrospective chart review of pediatric patients (<16 years) undergoing NF from 1980-1997 with preoperative DGE diagnosis and ≥6 months follow-up.
  • DGE defined as >50% gastric retention at 90 minutes post-radiolabeled meal.

Related Experiment Videos

  • Recurrent GER confirmed by postoperative esophagram or 24-hour pH monitoring.

    • Main Results:

    • 92 patients with DGE were analyzed; 20 without GEP and 72 with GEP. The GEP group had higher preoperative gastric retention and a higher prevalence of neurological impairment.
    • No GEP complications were reported.
    • Recurrent reflux rate was 35.0% in the no-GEP group versus 18.1% in the GEP group, indicating a near doubling of risk without GEP (RR=1.94).

    Conclusions:

    • Children with DGE undergoing NF without GEP experienced a higher frequency of recurrent GER.
    • Preoperative screening for DGE is crucial.
    • Concurrent operative correction of DGE during fundoplication is recommended to reduce GER recurrence.