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Preventive antireflux surgery in patients with congenital diaphragmatic hernia

Caroline Chamond1, Marianne Morineau, Ghania Gouizi

  • 1Département de Chirurgie Pédiatrique, Hôpital Saint-Vincent de Paul, 74-82 av Denfert-Rochereau, 75014, Paris, France. caroline.chamond@svp.aphp.fr

World Journal of Surgery
|September 13, 2008
PubMed

Insights

Preventive fundoplication in infants with congenital diaphragmatic hernia (CDH) significantly reduced gastroesophageal reflux (GER) but did not impact nutritional outcomes. This suggests selective use in specific CDH cases.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neonatal Care

Background:

  • Gastroesophageal reflux (GER) is a common complication in children with congenital diaphragmatic hernia (CDH).
  • Optimal management strategies for GER in CDH patients remain unclear.
  • This study investigates the impact of preventive fundoplication during initial CDH repair.

Purpose of the Study:

  • To evaluate the efficacy of a preventive fundoplication in reducing GER and nutritional morbidity in infants with left CDH.
  • To determine if performing fundoplication during the initial surgery improves outcomes for CDH patients.

Main Methods:

  • A retrospective study comparing 17 patients with preventive fundoplication (Group A) and 19 patients without (Group B).
  • Patients were classified by disease severity (mild, intermediate, severe) based on liver position and need for patch repair.
  • Clinical data were analyzed with a mean follow-up of 3 years.

Main Results:

  • The incidence of GER was significantly lower in Group A (17.6%) compared to Group B (52.6%) at 1-year follow-up (p < 0.5).
  • Group B patients had a higher rate of requiring fundoplication before 6 months (30%).
  • No significant differences were observed in hospitalization duration, need for nutritional supplementation, gastrostomy, or growth retardation between the groups.

Conclusions:

  • Adding antireflux surgery to left CDH repair is recommended only for patients with intrathoracic liver and/or requiring patch repair.
  • Selective use of fundoplication may be beneficial for specific subgroups of CDH patients.
Abstract

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