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Effects and efficacy of laparoscopic fundoplication in children with GERD: a prospective, multicenter study

Femke A Mauritz1,2, J M Conchillo3, L W E van Heurn4

  • 1Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands. femkemauritz@gmail.com.

Surgical Endoscopy
|July 3, 2016
PubMed

Insights

Laparoscopic antireflux surgery (LARS) effectively reduces reflux symptoms and acid exposure in children with therapy-resistant gastroesophageal reflux disease (GERD). Higher preoperative reflux episodes predict better surgical outcomes for GERD treatment.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Medical device technology

Background:

  • Therapy-resistant gastroesophageal reflux disease (GERD) in children often necessitates surgical intervention.
  • Laparoscopic antireflux surgery (LARS) is a common approach to manage persistent GERD symptoms.
  • Objective assessment of LARS efficacy and identification of failure predictors are crucial for optimizing pediatric GERD management.

Purpose of the Study:

  • To objectively evaluate the effect and efficacy of LARS in pediatric patients with GERD.
  • To identify clinical parameters associated with successful LARS outcomes.
  • To assess changes in reflux events, symptoms, and esophageal function post-LARS.

Main Methods:

  • Prospective study of 25 children with GERD undergoing LARS.
  • Pre- and post-operative assessments included reflux questionnaires, manometry, 24-h multichannel intraluminal impedance pH monitoring (MII-pH), and a breath test.
  • Analysis focused on changes in reflux parameters, lower esophageal sphincter (LES) function, and gastric emptying.

Main Results:

  • LARS significantly reduced total acid exposure time (AET) and the number of reflux episodes.
  • Lower esophageal sphincter (LES) resting pressure significantly increased post-LARS.
  • Preoperative MII-pH monitoring showing a higher number of reflux episodes predicted better reflux reduction after LARS.

Conclusions:

  • LARS is effective in reducing reflux symptoms and acid exposure in children with therapy-resistant GERD.
  • The procedure improves LES resting pressure without affecting esophageal motility or gastric emptying.
  • Children with a higher preoperative reflux burden may experience superior outcomes from LARS.
Abstract

Keywords:
ChildrenEfficacyFundoplicationGERDPediatricReflux

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