Gastrointestinal complications of fundoplication

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Technical Considerations and Approach to Redo Foregut Surgery
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Frances Connor1

  • 1Department of Gastroenterology, Hepatology and Nutrition, Royal Children's Hospital, Herston Road, Herston, Brisbane, QLD 4029, Australia. flconnor@tpgi.com.au

Current Gastroenterology Reports
|May 26, 2005
PubMed

Insights

Fundoplication surgery is effective for children with severe acid reflux. However, some patients experience gastrointestinal issues post-surgery, requiring further investigation for proper management.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Digestive Health

Background:

  • Medically refractory gastroesophageal reflux disease (GERD) in children often necessitates surgical intervention.
  • Fundoplication is a common surgical procedure for managing GERD in pediatric patients.
  • While generally safe and effective, a subset of patients develop postoperative gastrointestinal (GI) dysfunction.

Purpose of the Study:

  • To outline the spectrum of postoperative gastrointestinal dysfunctions following fundoplication in children.
  • To identify potential causes and diagnostic approaches for these complications.
  • To guide clinical management strategies for pediatric patients experiencing post-fundoplication GI issues.

Main Methods:

  • Review of clinical presentations and outcomes in pediatric patients undergoing fundoplication.
  • Analysis of diagnostic investigations including pHmetry, videofluoroscopy, endoscopy, and motility studies.
  • Evaluation of dumping provocation testing for suspected rapid gastric emptying.

Main Results:

  • Postoperative symptoms can include chest pain, dysphagia (5%), gas bloat (2-4%), diarrhea (up to 20%), and dumping syndrome (up to 30%).
  • These symptoms may stem from recurrent GERD, surgical complications (e.g., wrap disruption), functional disturbances (e.g., rapid gastric emptying), or alternative diagnoses.
  • Diagnostic workup is crucial for differentiating causes and guiding treatment.

Conclusions:

  • Fundoplication is a viable treatment for refractory GERD in children, but vigilance for postoperative GI dysfunction is essential.
  • A systematic and detailed investigation is required to determine the underlying cause of persistent or new-onset GI symptoms.
  • Accurate diagnosis is key to effective management and improving patient outcomes after pediatric fundoplication.

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