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Antireflux surgery in children under 3 months of age
E W Fonkalsrud1, J Bustorff-Silva, C A Perez
1Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, CA 90095-1749, USA.
Insights
Fundoplication is a safe surgical option for infants under three months experiencing severe gastroesophageal reflux disease (GERD). This procedure effectively resolves symptoms like emesis and aspiration in most young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux disease (GERD) significantly impacts infants, causing symptoms like recurrent emesis and respiratory issues.
- Surgical intervention, such as fundoplication, is considered for severe or refractory GERD in infants.
- Infants under three months present unique challenges due to their delicate physiology and potential comorbidities.
Purpose of the Study:
- To evaluate the indications for and outcomes of fundoplication in infants younger than three months.
- To assess the safety and efficacy of surgical management for GERD in this specific pediatric population.
Main Methods:
- A retrospective chart review of 110 infants under three months undergoing fundoplication between 1980 and 1997.
- Analysis of indications including recurrent emesis, respiratory symptoms, and neurological impairment.
- Review of surgical procedures (Nissen or Thal fundoplication), associated procedures, complications, and follow-up data.
Main Results:
- The primary indications were recurrent emesis (62/110) and respiratory symptoms (85/110), with 73.6% having associated major malformations or disorders.
- Nissen fundoplication was performed in 104 infants; 7 infants experienced complications.
- Symptom resolution was achieved in 79% of infants, with significant improvements in emesis, aspiration, and apneic spells.
Conclusions:
- Fundoplication is a safe and effective procedure for infants under three months with symptomatic GERD.
- The surgery demonstrates low mortality and morbidity rates in this young population.
- Successful symptom resolution supports fundoplication as a viable treatment option for severe infant GERD.
Purpose:
The aim of this study was to analyze the indications and results of fundoplication in 110 infants under 3 months of age.
Methods:
A retrospective review was conducted on the charts of all infants operated on for gastroesophageal reflux disease (GERD) at the UCLA Medical Center from January 1980 to December 1997. There were 59 boys and 51 girls. Recurrent emesis was the indication for operation in 62 of 110 infants, and respiratory symptoms in 85 of 110, with 54 of 110 having both. Neurological impairment was present in 32%. Prematurity was present in 21%; 35% had associated anomalies. Overall, 81 of 110 infants (73.6%) had one or more associated major malformations or disorders. Reflux was confirmed by upper gastrointestinal series findings in 63 of 78, esophageal pH monitoring in 60 of 62, and endoscopy in five of seven.
Results:
Mean age at operation was 1.8+/-0.1 months and mean weight was 3,686+/-90.2 g. A Nissen fundoplication was performed on 104 children, and six underwent a Thal procedure. Thirty-one had a gastric emptying procedure for delayed gastric emptying. Complications occurred in 7 infants. Emesis was controlled in 57 of 62 patients, aspiration in 38 of 48, and apneic spells in 54 of 57. Follow-up greater than 6 months was available for 73 patients. There were nine late deaths, all related to severe associated malformations. Seven patients required a redo fundoplication for recurrent reflux.
Conclusions:
Nissen fundoplication can be performed safely in symptomatic infants under 3 months of age with low mortality and morbidity rates and with resolution of the presenting symptoms in 79% of infants.