Pediatric surgeons and gastroesophageal reflux
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Updated: Jul 17, 2026
Conditional Reprogramming of Pediatric Human Esophageal Epithelial Cells for Use in Tissue Engineering and Disease Investigation
Published on: March 22, 2017
Juan A Tovar1, Ana L Luis, Jose L Encinas
1Department of Pediatric Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain. jatovar.hulp@salud.madrid.org
Insights
Fundoplication effectively controls reflux in children, especially those with specific comorbidities. While complications occurred, long-term wrap integrity and satisfactory functional results were achieved in most cases, highlighting its value in pediatric surgery.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes
Background:
- The indications for pediatric fundoplication are evolving due to advancements in antacid medications and the advent of laparoscopy.
- This study reviews the indications, surgical approaches (open vs. laparoscopic), and outcomes of fundoplication in 252 refluxing children operated between 1992 and 2006.
Discussion:
- Laparoscopic fundoplication was more common in children with digestive, respiratory, or neurologic symptoms, while open surgery predominated for other comorbidities.
- Complication rates were higher with laparotomy (22% overall), emphasizing the need for careful surgical technique.
- The study discusses the long-term integrity of the fundoplicated wrap, analyzing success rates across different patient groups.
Key Insights:
- Overall wrap integrity was maintained in 89% of patients, with higher rates in symptom-based groups (95% digestive/respiratory) compared to complex comorbidities (e.g., 72% esophageal atresia).
- Functional results were satisfactory in 83% of cases, with a low operative mortality rate of 0.4%.
- Fundoplication remains a powerful tool for reflux control, particularly in symptomatic cases refractory to medical management or with specific comorbidities.
Outlook:
- The findings support fundoplication as a valuable surgical option for carefully selected pediatric patients with gastroesophageal reflux disease.
- Maintaining high technical standards and rigorous outcome reporting is crucial for the continued relevance of pediatric fundoplication.
- Further discussion is needed among pediatric surgeons to refine indications and optimize surgical approaches for this procedure.
Background/Aims:
Better antacid medications and the introduction of laparoscopy destabilize the indications for fundoplication. This study aims at raising a discussion among pediatric surgeons on these indications, modalities, and the results of this operation.
Materials And Methods:
A total of 252 refluxing children operated between 1992 and 2006 were divided into groups according to predominant symptoms (93 digestive, 47 respiratory, and 68 neurologic) or to comorbidities (27 esophageal atresia, 10 diaphragmatic hernia, 5 abdominal wall defects, and 2 caustic stricture), and the indications, complications, mortality, and long-term results were reviewed. Features of open (n = 135) and laparoscopic (n = 117) approaches were compared, and long-term integrity of the wrap was analyzed using the Kaplan-Meier method.
Results:
Digestive, respiratory, and neurologic patients had more often laparoscopic plications, whereas all others rather had an open approach. The rate of complications was 22%, and they were more frequent in children operated by laparotomy (P < .05). Median follow up was 51.3 months (range, 6-160). Overall wrap integrity was maintained in 89% of the children, and the proportions for digestive, respiratory, and neurologic groups were 95%, 95%, and 87%, respectively. For esophageal atresia, congenital diaphragmatic hernia, abdominal wall defects, and caustic stricture, they were 72%, 77%, 100%, and 0%, respectively. The functional results were fully satisfactory in 83% of patients. There were 17 deaths (6.7%), but only 3 in the first postoperative month and only 1 related to the operation (0.4%).
Conclusions:
Fundoplication is a powerful method of reflux control. It is indicated after failure of medical treatment in gastroesophageal reflux disease and in symptomatic refluxers with some particular comorbidities. Surgery should be offered only after diagnosis has been firmly established, and the indications must remain identical for open and laparoscopic procedures. High technical standards and rigorous report of the results are required for keeping a relevant place of pediatric surgery in the treatment of this disease.
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