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Results of fundoplication in a UK paediatric centre
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Fundoplication surgery effectively controls gastro-oesophageal reflux in children. Routine crural repair may reduce major complications like paraoesophageal hernia.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastro-oesophageal reflux (GER) is a common condition in children.
- Fundoplication is a surgical procedure to treat severe GER.
- Complications and long-term efficacy require evaluation.
Purpose of the Study:
- To assess the efficacy and complication rates of fundoplication in pediatric patients.
- To identify factors contributing to surgical complications.
- To evaluate management of esophageal strictures post-fundoplication.
Main Methods:
- Retrospective review of 55 children undergoing fundoplication (age 3 months to 16 years).
- Analysis of complication types, incidence, and associated factors.
- Evaluation of outcomes for patients with pre-existing esophageal strictures.
Main Results:
- 16% of patients experienced major complications, including paraoesophageal hernia and prolonged ileus.
- Omission of crural repair was significantly associated with paraoesophageal hernia/recurrence.
- Surgery achieved 100% short-term and 89% 1-6 year follow-up reflux control.
- Esophageal strictures showed good response to fundoplication, dilatation, or colon interposition.
Conclusions:
- Fundoplication is effective for pediatric GER control.
- Routine crural repair is recommended to minimize complications.
- Multimodal approaches are effective for managing associated esophageal strictures.
Abstract:
Of 55 children (age 3 months to 16 years) who had fundoplication, major complications occurred in nine (16 per cent): paraoesophageal hernia (five cases), prolonged ileus (two cases), recurrent gastro-oesophageal reflux (one case), and accidental perforation (one case). The single most important factor resulting in complications was the omission of crural repair; of seven patients without crural repair, five developed paraoesophageal hernia/recurrence. Four patients required repeat fundoplication for severe recurrent symptoms and one of these developed the unusual complication of pericardiogastric fistula. Thirteen patients had strictures before operation from reflux oesophagitis, six (46 per cent) resolved after fundoplication alone, six responded to dilatation (mean five sessions), and one required colon interposition. Our preliminary experience with balloon dilatation was encouraging: three of three patients responded after one dilatation only. These results confirmed the efficacy of surgery in controlling reflux: 100 per cent in the short-term and 89 per cent on a 1-6 year follow-up. Major complications might well be reduced by routine crural repair.