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Effectiveness of fundoplication in early infancy
1Institute of Child Health and Great Ormond Street Hospital for Children, University College London Medical School, England.
Insights
Fundoplication in infants under 4 months has mixed results, with higher failure rates in those with anomalies. Early surgery is best for vomiting and respiratory issues, not failure to thrive.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) is a common condition in infants.
- Fundoplication is a surgical procedure to treat GER.
Purpose of the Study:
- To evaluate the outcomes of fundoplication in infants younger than 4 months.
- To identify factors influencing the success of early-life fundoplication.
Main Methods:
- Retrospective review of 66 infants under 4 months who underwent fundoplication.
- Diagnosis of GER confirmed by barium meal or 24-hour pH monitoring.
- Follow-up duration averaged 24 months.
Main Results:
- Fundoplication was performed at a median age of 9 weeks.
- Infants with isolated GER showed a 90% clinical improvement, compared to 64% with associated anomalies.
- Vomiting and respiratory symptoms improved in 76% and 66% of infants, respectively.
- Revision surgery was needed in 24% of patients.
Conclusions:
- Fundoplication in early infancy has a high failure rate, particularly in infants with congenital anomalies.
- Associated anomalies significantly impact the success of fundoplication.
- Infants with emesis and respiratory symptoms experienced the best outcomes.
Purpose:
The aim of this study was to evaluate the results of fundoplication performed in the first 4 months of life.
Methods:
Case-notes of 66 patients less than 4 months old who underwent fundoplication between January 1986 and July 1997 were reviewed. The mean length of follow-up was 24 months (range, 3 to 115 months). Diagnosis of gastrooesophageal reflux (GOR) was based on a barium meal in 55 patients or 24-hour pH monitoring in 23 patients.
Results:
Fundoplication was performed at a median age of 9 weeks (range, 3 to 15 weeks). Associated anomalies were identified in 56 infants and included oesophageal atresia or tracheooesophageal fistula (n = 19), lung abnormalities (n = 7), congenital diaphragmatic hernia (n = 4), and various other complex syndromes including neurological disorders (n = 26). Isolated GOR occurred in 10. Ninety percent of infants with isolated GOR improved clinically after the fundoplication compared with 64% of those with associated anomalies. Only 58% of infants in whom GOR developed after oesophageal atresia repair improved after fundoplication. Vomiting was reduced after fundoplication in 76% of infants, apnoea and/or respiratory symptoms improved in 66%, whereas failure to thrive incidence improved in only 38% of infants. Revision of the fundoplication was required in 16 (24%) patients. There were eight deaths, all of which occurred at least 6 months after the fundoplication.
Conclusions:
Fundoplication in early infancy is unsuccessful in a high proportion of patients. The highest incidence of failure and redo fundoplication occurred in infants with associated anomalies. The best results were achieved in infants with emesis and respiratory symptoms.