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Laparoscopic fundoplication in mentally normal children with gastroesophageal reflux disease
K V Menon1, M Booth, J Stratford
1Department of Surgery and Oesophageal Laboratory, Royal Berkshire Hospital, Reading, UK.
Insights
Laparoscopic fundoplication is effective for children with gastroesophageal reflux disease (GERD) unresponsive to medication. This minimally invasive surgery offers significant symptom improvement and reduced acid exposure in pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux disease (GERD) is common in children.
- Medical therapy is the first line of treatment for pediatric GERD.
- Surgical intervention is considered for refractory cases.
Purpose of the Study:
- To evaluate the effectiveness of laparoscopic fundoplication in mentally normal children with GERD.
- To assess surgical outcomes in patients who failed medical management.
- To compare pre- and postoperative GERD indicators.
Main Methods:
- Prospective data collection on 12 children (aged 9-15) with GERD.
- Laparoscopic Nissen or Toupet fundoplication performed.
- Pre- and postoperative 24-h pH monitoring, DeMeester and Johnson scores, Visick grades, and symptom scores analyzed.
Main Results:
- Significant reduction in median acid exposure time (AET) from 4.7% to 0.4%.
- High success rate with 7 patients achieving Visick grade I and 5 achieving grade II.
- Postoperative dysphagia occurred in 4 patients, requiring dilatations.
Conclusions:
- Laparoscopic fundoplication is a safe and effective treatment for pediatric GERD refractory to medical therapy.
- The procedure leads to significant improvement in objective GERD markers and clinical symptoms.
- Minimally invasive antireflux surgery offers a viable option for selected pediatric populations.
Abstract:
Laparoscopic antireflux surgery has been performed in neurologically impaired and scoliotic children. We aimed to assess the effectiveness of laparoscopic fundoplication in mentally normal children with gastroesophageal reflux disease that failed to respond to medical therapy. Data were prospectively collected (symptoms, medical therapy, endoscopies' findings) on 12 children (nine boys, three girls) aged 9-15 years with gastroesophageal reflux disease. Pre- and postoperative ambulatory 24-h pH and DeMeester and Johnson scores were also recorded. Effectiveness of surgery was assessed by comparison of pre- and postoperative total acid exposure time, Visick grade, need for antireflux medication and symptom scores. In total, 11 children underwent a laparoscopic Nissen fundoplication and one underwent a Toupet procedure. Median length of stay was 2 (2-3) nights. The median preoperative pH acid exposure time (AET) was 4.7 (0.8-16.4) percent compared with postoperative AET of 0.4 (0-3) percent. Early postoperative dysphagia occurred in four out of 12 patients, requiring a total of six dilatations. Postoperative Visick scores were: grade I=7 and grade II=5. Laparoscopic fundoplication can be safely performed and is effective in children with GERD who have failed to respond to medical therapy.
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