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Updated: Jun 1, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Outcomes in children with hypoplastic left heart syndrome undergoing open fundoplication
Carissa L Garey1, Carrie A Laituri, Pablo Aguayo
1Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
Fundoplication in infants with hypoplastic left heart syndrome (HLHS) is associated with significant risks. Early surgery for gastroesophageal reflux disease in HLHS patients carries high morbidity and mortality, warranting careful consideration.
Area of Science:
- Pediatric Surgery
- Cardiology
- Gastroenterology
Background:
- Hypoplastic left heart syndrome (HLHS) patients with GERD are sometimes recommended for early fundoplication.
- However, their unique cardiac physiology presents high perioperative risks.
Purpose of the Study:
- To assess the risk-benefit ratio of fundoplication in HLHS patients.
Main Methods:
- Retrospective review of 39 HLHS patients who underwent open fundoplication between 1990 and 2009.
- Procedures were performed between the first and second stages of cardiac repair.
Main Results:
- 3 intraoperative complications occurred, including hemodynamic instability and pulmonary hypertensive crisis.
- 27 postoperative complications were observed in 16 patients, with 4% 30-day mortality and 23% mortality before the second cardiac repair stage.
Conclusions:
- Noncardiac surgery in palliated HLHS patients carries substantial morbidity and mortality.
- Routine fundoplication should be reserved for prospective studies to clarify risks versus reflux benefits.
Background/Purpose:
Some institutions recommend early fundoplication in patients with hypoplastic left heart syndrome (HLHS) with signs of gastroesophageal reflux disease because of the risk of reflux-related cardiac events. However, their cardiac physiology may impose high perioperative morbidity and mortality. Therefore, we reviewed our experience with fundoplication in this population to allow for assessment of the risk-benefit ratio.
Methods:
A retrospective review of patients with a diagnosis of HLHS who underwent a fundoplication from January 1990 to July 7, 2009, was performed. All patients underwent open fundoplication between first and second stages of cardiac repair.
Results:
Thirty-nine patients were identified. There were 3 intraoperative complications: hemodynamic instability (n = 2) and a pulmonary hypertensive crisis requiring extracorporeal membrane oxygenation and termination of the procedure (n = 1). There were 27 postoperative complications in 16 patients. There were 2 deaths (4%) within 30 days, and there were 9 deaths (23%) in patients between their first and second stage of cardiac repair during the study period.
Conclusions:
Noncardiac surgical procedures in patients palliated for HLHS have a high morbidity and mortality. We recommend that routine fundoplication in this population should only be performed under prospective protocols until the relative risk of operation vs risk of reflux is delineated.
