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Published on: September 22, 2023
Is fundoplication required after the Foker procedure for long gap esophageal atresia?
Dylan Wanaguru1, Catherine Langusch1, Usha Krishnan2
1The Toby Bowring Department of Paediatric Surgery, Sydney Children's Hospital, Sydney, Australia.
Insights
Routine fundoplication may not be necessary for infants undergoing the Foker procedure (FP) for long gap esophageal atresia (LGEA). This study suggests delaying fundoplication until medically necessary can achieve good outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Atresia Management
Background:
- Fundoplication is standard for Foker procedure (FP) in long gap esophageal atresia (LGEA).
- This study explores pharmacological management and endoscopic surveillance instead of early fundoplication in FP infants.
Purpose of the Study:
- To evaluate outcomes of delayed fundoplication in infants treated with the Foker procedure for LGEA.
- To assess the efficacy of medical management and endoscopic surveillance as alternatives to early fundoplication.
Main Methods:
- Retrospective chart review of children treated with the Foker procedure.
- Analysis of outcomes including time to anastomosis, esophageal preservation, complications, and need for fundoplication.
Main Results:
- Nine children underwent FP; median time to anastomosis was 22 days.
- All patients retained their native esophagus; three had minor, nonoperative anastomotic leaks.
- All required stricture dilatation; all received proton pump inhibitors. Two underwent fundoplication for refractory esophagitis.
Conclusions:
- Early fundoplication may not be universally required for LGEA patients treated with FP.
- Delaying fundoplication until medically indicated for resistant gastroesophageal reflux disease can lead to favorable long-term results.
Background:
Fundoplication has been performed almost universally in children treated with the Foker procedure (FP) for long gap esophageal atresia (LGEA). We report our experience with pharmacological management and endoscopic surveillance rather than early routine fundoplication in infants treated with the FP.
Methods:
A retrospective chart review was performed of all children treated with the Foker procedure at our institution.
Results:
Nine children have undergone the FP since 2007. Median time between FP and definitive anastomoses was 22days. All nine children kept their native esophagus. There were three minor anastomotic leaks, all treated nonoperatively. All children required dilatation of anastomotic strictures (range 2-15). All have been treated with proton pump inhibitors. Three children had eosinophilic esophagitis and one had Barrett's esophagus. Only two children in this series have undergone fundoplication, which was performed for symptomatic and persistent erosive esophagitis.
Conclusion:
The question of early versus delayed fundoplication in LGEA patients managed with the FP remains unanswered. Our series demonstrates that it is possible to achieve good long-term outcomes when the operation is reserved for children with gastroesophageal reflux disease resistant to maximal medical therapy.
Level Of Evidence:
IV.
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