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Dumping syndrome: a common problem following Nissen fundoplication in young children
P Bufler1, C Ehringhaus, S Koletzko
1Kinderpoliklinik der Ludwig-Maximilians-Universität München, Germany.
Insights
Dumping syndrome (DS) can occur in young children after Nissen fundoplication surgery. Early diagnosis and intensive follow-up are crucial for managing this condition and ensuring proper growth.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Nissen fundoplication is a common antireflux surgery in children.
- Dumping syndrome (DS) is a potential complication, characterized by rapid gastric emptying.
- Understanding DS post-fundoplication is critical for pediatric patient outcomes.
Observation:
- Six children aged 3 months to 4 years developed DS after Nissen fundoplication.
- Symptoms included tachycardia, diaphoresis, lethargy, retching, diarrhea, and failure to thrive.
- One case involved gastric herniation and suggested vagal nerve damage.
Findings:
- Oral glucose tolerance tests did not correlate with DS symptom severity.
- Five children required continuous intragastric feeding initially.
- A carbohydrate-modified diet improved tolerance in some patients.
Implications:
- Delayed diagnosis of DS is common despite characteristic symptoms.
- Intensive postoperative follow-up is essential after pediatric antireflux surgery.
- This highlights the need for vigilant monitoring for DS in children post-fundoplication.
Abstract:
Within a 3-year period we observed six children, aged 3 months to 4 years, with dumping syndrome (DS) following Nissen fundoplication. Five were neurologically normal and one was slightly mentally retarded. Symptoms included postprandial tachycardia, diaphoresis, lethargy, severe retching, meteorism or gas-bloat syndrome, watery diarrhea, refusal to eat with failure to thrive, and developmental delay. Results of an oral glucose tolerance test did not correlate with the severity of symptoms. In one child severe retching led to recurrent paraesophageal gastric herniation, necessitating two reoperations and a gastrostomy. A lack of meal stimulated pancreatic polypeptide release in this patient indicated vagal damage. Initially five of the six children needed continuous intragastric feeding until bolus application of a carbohydrate-modified diet was tolerated. We conclude that the diagnosis of DS is often delayed in spite of characteristic clinical signs. Intensive postoperative follow-up after antireflux surgery should be mandatory in children.