Failed Nissen fundoplication in children: causes and management

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Outcomes

Background:

• Nissen fundoplication (NF) is the standard surgical treatment for pediatric gastroesophageal reflux (GER).
• A significant percentage of patients experience NF failure, necessitating further investigation into predictive factors and reoperation outcomes.

Purpose of the Study:

• To identify preoperative predictors of Nissen fundoplication failure in children.
• To evaluate the outcomes of reoperations for recurrent GER after initial NF.

Main Methods:

• Retrospective chart review of 360 children undergoing NF between 1992 and 2011.
• Analysis of comorbidities (neurologic impairment, esophageal atresia, congenital diaphragmatic hernia), surgical techniques, and postoperative complications.
• Logistic regression and chi-square tests were used to identify predictors of NF failure.

Main Results:

• NF failure occurred in 11.7% of patients, with reoperation rates of 9.7%.
• Esophageal atresia (31.6% failure) and congenital diaphragmatic hernia (46.7% failure) were significant predictors of NF failure.
• Postoperative complications occurred in 11.7% of patients, including wound infection and intestinal obstruction.

Conclusions:

• Preoperative identification of EA and CDH can predict NF failure in pediatric GER patients.
• Redo NF for recurrent GER shows a higher failure rate; esophageal replacement or esophagogastric dissociation should be considered for subsequent failures.