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Nissen fundoplication in infants and children: a long-term clinical study
Mostafa Abu Zeid1, Tharwat Kandel, Mohamed el-Shobary
1Gastroenterology Surgery Center, Mansoura University, Mansoura, Egypt. m_abu_zead@hotmail.com
Insights
Nissen fundoplication effectively treats pediatric gastroesophageal reflux disease when medication fails. Early surgical intervention in children can decrease the recurrence of reflux and improve outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Gastroesophageal reflux disease (GERD) significantly impacts infants and children.
- Nissen fundoplication is a surgical option for managing severe GERD.
- Evaluating the success and complications of open Nissen fundoplication in pediatric patients is crucial.
Purpose of the Study:
- To assess the efficacy of open Nissen fundoplication in treating pediatric GERD.
- To identify and evaluate complications associated with the procedure.
- To determine long-term outcomes of Nissen fundoplication in children.
Main Methods:
- Retrospective evaluation of 26 neurologically normal children (6 months to 11 years old) who underwent open Nissen fundoplication.
- Pre-operative and follow-up assessments included clinical history, barium meal studies, and gastroscopy with esophageal biopsies.
- Median follow-up duration was 28 months.
Main Results:
- The primary indication for surgery was persistent vomiting/regurgitation (92.3%).
- No mortality was observed; mean hospital stay was 4.1 days.
- 84.6% of patients experienced no recurrent reflux; complications included wrap disruption and re-stricture in some cases.
Conclusions:
- Open Nissen fundoplication is an effective surgical treatment for pediatric GERD unresponsive to medical therapy.
- Performing the operation before complications arise may reduce reflux recurrence.
- Timely surgical intervention is key to successful GERD management in children.
Background/Aims:
Infants and children who underwent open Nissen fundoplication for gastroesophageal reflux disease were retrospectively evaluated to assess the success and complications of this operation.
Methodology:
Twenty-six neurologically normal children (16 boys and 10 girls between 6 months and 11 years old) underwent Nissen fundoplication for intractable or complicated gastroesophageal reflux between October 1982 and February 2002. Before surgery and at follow-up visits, all children were subjected to thorough history, barium meal study and gastroscopy with multiple esophageal biopsies. The median follow-up period was 28 months (range: 11 months-19 years).
Results:
Persistent vomiting or regurgitation since birth was the main symptom (24 patients, 92.3%), chest symptoms occurred in 5 patients (19.2%), malnutrition and retarded growth were found in 4 patients (15.4%), hematemesis and/or melena occurred in 2 patients (7.7%) and dysphagia due to esophageal stricture occurred in 4 patients (15.4%). There was no mortality. The mean hospital stay was 4.1 days. Twenty-two patients (84.6%) had no recurrent reflux. Reflux symptoms recurred in 4 cases (15.4%). One of these cases had no evidence of recurrent pathological reflux, 2 cases with preoperative stricture developed wrap disruption, recurrent reflux and re-stricture. Both refused a second operation. The fourth case developed melena and reflux esophagitis due to wrap herniation through the hiatus and was successfully managed by a second operation.
Conclusions:
Nissen fundoplication is an effective operation to correct gastroesophageal reflux in infants and children when the drug therapy fails. The operation should be done before occurrence of complications to decrease the recurrence of reflux.
