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Operative treatment for the gastroesophageal reflux syndrome in children
E W Fonkalsrud1, R P Foglia, M E Ament
1Department of Surgery, UCLA School of Medicine 90024.
Insights
Surgical intervention for symptomatic gastroesophageal reflux (GER) in children found that over 35% had motility disorders and 50% had delayed gastric emptying (DGE). Pyloroplasty combined with gastroesophageal fundoplication (GEF) is beneficial for significant DGE.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastroesophageal Reflux Disease
Background:
- Symptomatic gastroesophageal reflux (GER) affects many infants and children.
- Associated conditions like esophageal motility disorders and delayed gastric emptying (DGE) are common in these patients.
Purpose of the Study:
- To evaluate the surgical outcomes for symptomatic GER in pediatric patients.
- To determine the efficacy of pyloroplasty in conjunction with gastroesophageal fundoplication (GEF) for GER, particularly in cases with DGE.
Main Methods:
- A retrospective review of 420 infants and children undergoing surgical treatment for GER over 19 years.
- Analysis of patient data including presence of motility disorders, DGE, and surgical procedures performed (GEF alone, GEF with pyloroplasty, pyloroplasty alone).
- Assessment of gastric retention using technetium-99m sulphur colloid scintigraphy to identify significant DGE.
Main Results:
- Over 35% of patients had esophageal motility disorders, and approximately 50% had DGE.
- Gastroesophageal fundoplication (GEF) was performed in 357 patients, while 51 underwent GEF and pyloroplasty.
- Pyloroplasty was found useful with >60% gastric retention at 90 minutes; 22% of recent cases included combined pyloroplasty and GEF.
- Low incidence of complications and absence of persistent dumping suggest increased utility of pyloroplasty for significant DGE.
Conclusions:
- Gastric emptying studies are beneficial for pediatric patients evaluated for severe GER, especially those with neurological disorders.
- Children with severe reflux and esophageal dysmotility may benefit from a loose GEF.
- Pyloroplasty should be considered more frequently in pediatric GER surgery when significant DGE is present, given its safety and efficacy.
Abstract:
Surgical treatment for symptomatic gastroesophageal reflux (GER) was performed on 420 infants and children over a 19-year period. Esophageal motility disorders were present in more than 35% of patients and delayed gastric emptying (DGE) was present in approximately 50% of patients studied. Gastroesophageal fundoplication (GEF) alone was performed for 357 patients, whereas 51 patients underwent GEF and pyloroplasty; 12 patients underwent pyloroplasty alone. When there is more than 60% gastric retention of technetium-99m sulphur colloid in semisolid feedings at 90 minutes, pyloroplasty appears to be useful. Twenty-two percent of the last 275 refluxing children underwent pyloroplasty combined with GEF. Most infants and young children undergoing evaluation for severe GER, particularly those with neurologic disorders, may benefit from having a gastric emptying study. Children with severe reflux and esophageal dysmotility should have a loose GEF performed. The absence of persistent dumping, and the very low incidence of complications suggests that pyloroplasty should be used more frequently when significant DGE is present.