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Preventive antireflux surgery in neonates with congenital diaphragmatic hernia: a single-blinded prospective study
Susanne Maier1, Katrin Zahn, Lucas M Wessel
1Department of Pediatric Surgery, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim 68167, Germany. sausai@web.de
Insights
Fundoplication surgery alongside congenital diaphragmatic hernia (CDH) repair may benefit infants in the first year. However, this antireflux procedure is not recommended as standard for all left-sided CDH cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Congenital diaphragmatic hernia (CDH) is associated with gastroesophageal reflux (GER), causing pulmonary and nutritional issues.
- Antireflux surgery is a potential intervention for GER in CDH patients.
Purpose of the Study:
- To evaluate the benefits of adding antireflux surgery (fundoplication) during CDH repair.
- To assess the impact on GER symptoms and patient outcomes.
Main Methods:
- Prospective, randomized, patient-blinded study of 79 neonates with left-sided CDH.
- Comparison between standard hernia repair (43 patients) and hernia repair with fundoplication (36 patients).
- Follow-up at 6, 12, and 24 months with questionnaires, radiographs, upper GI series, and pH-metry for GER evaluation.
Main Results:
- GER symptoms were more frequent in the non-fundoplication group at 6 months, but this difference diminished by 24 months.
- Body weight development was similar between groups over the first two years.
- No complications were reported from the antireflux surgery.
Conclusions:
- Fundoplication provides benefits in GER management for CDH patients primarily within the first year of life.
- Simultaneous fundoplication is not currently recommended as a routine procedure for all left-sided CDH repairs.
Objective:
Congenital diaphragmatic hernia (CDH) is known to be a predisposing factor in gastroesophageal reflux (GER) leading to pulmonary and nutritional problems. The aim of this prospective, randomized, patient-blinded study was to evaluate the benefit of antireflux surgery at the time of CDH repair.
Methods:
From 2003 to 2009, 79 neonates with left-sided CDH were included. Forty-three had regular hernia closure. Thirty-six patients additionally had fundoplication at hernia repair. Follow-up was at 6, 12, and 24 months after birth with a standardized questionnaire and a thorax radiograph. Patients with clinical signs for GER were evaluated with upper gastrointestinal series and 24-hour pH-metry.
Results:
Seventy-nine of 263 patients participated in this prospective trial. Survival rate was 88.61%. The GER symptoms were almost significantly more frequent in the group without concomitant fundoplication at the age of 6 months. At 24 months, the difference between both groups was not significant anymore. Development of body weight in the first 2 years of life was similar in both groups. No complications related to initial antireflux surgery were noted.
Conclusion:
Patients profit from fundoplication at CDH repair only within the first year of life. At the present point of this study, simultaneous fundoplication at the time of primary CDH repair cannot be recommended as a standard procedure in all patients with left-sided CDH.
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