Related Experiment Videos
[Long-term evolution of esophago-gastric junctions surgically treated to correct gastro-esophageal reflux. 111 cases]
P Vaysse1, C Baunin, J Guitard
1Département de Chirurgie Pédiatrique Viscérale, Hôpital Purpan, Toulouse.
Insights
Surgical correction for severe gastroesophageal reflux in children can lead to esophago-gastric junction anomalies, with most being minor and asymptomatic. However, significant anomalies may require reoperation, especially in mentally retarded children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Intractable gastroesophageal reflux disease (GERD) often requires surgical intervention in pediatric populations.
- Long-term follow-up is crucial to assess the efficacy and potential complications of GERD surgery.
- The presence of severe mental retardation may influence surgical outcomes and complication rates.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical correction for intractable gastroesophageal reflux in children.
- To identify the incidence and characteristics of post-operative esophago-gastric junction anomalies.
- To assess the impact of patient factors, such as mental retardation, on surgical results.
Main Methods:
- A retrospective review of 111 pediatric patients who underwent surgery for intractable GERD.
- Serial upper gastro-intestinal (GI) series performed at various post-operative intervals (10 days, 1 year, 5 years, and beyond).
- Analysis of anomaly types, frequency, associated symptoms, and need for reoperation.
Main Results:
- All 111 patients had normal initial post-operative upper GI series.
- Esophago-gastric junction anomalies were observed in 44% of patients, primarily within the first post-operative year.
- Minor anomalies (e.g., occasional reflux, small paraesophageal hernia) were common (37%) and mostly asymptomatic.
- Significant anomalies (e.g., recurrent large paraesophageal hernia) occurred in 7% of patients, more frequently in those with severe mental retardation and partial posterior fundoplication, necessitating reoperation in 5 cases.
Conclusions:
- While most post-operative esophago-gastric junction anomalies after GERD surgery are minor and transient, significant complications can occur.
- Partial posterior fundoplication is associated with a higher risk of recurrence, particularly in severely mentally retarded children.
- Alternative surgical approaches, such as the Collis procedure, may be preferred for mentally retarded children to minimize reoperation risks.
Abstract:
One hundred eleven patients underwent a surgical procedure for correction of intractable gastroesophageal reflux. Twenty children were severely mentally retarded. The range of follow up was 6 months to 15 years. Upper gastro-intestinal series was realised at tenth post-operative day for 111 children, then during the first year for 97 children, between the first and fifth year for 62 children and after the fifth year for 25 children. The first upper gastro-intestinal control (at tenth day) was normal for 111 patients. Next controls revealed, usually during the first post-operative year, an esophago-gastric junction anomaly for 49 patients (44%). Most of them are light (41/111 = 37%): occasional reflux (9 children; more frequent without pyloroplasty) of little paraesophageal hernia (32 children; more frequent with closure of esophageal hiatus by two suture lines, with esophageal fixation on median arcuatum ligament or without esophageal fixation on esophageal hiatus); these light anomalies are symptom free and sometimes transitories. Rarely, anomalies are important (8/111 = 7%): big paraesophageal hernia of recurrence (more frequent with partial posterior fundoplication and in children severely mentally retarded); five patients were symptomatic and had to be reoperated. Also now, we don't use partial posterior fundoplication and in mentally retarded children we prefer a Collis procedure.