Related Experiment Video
Updated: Jul 23, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Outcome of Surgery for Pediatric Gastroesophageal Reflux: Clinical and Endoscopic Follow-up after 300 Fundoplications
A I Koivusalo1, M P Pakarinen1
1Section of Paediatric Surgery, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
Insights
Fundoplication effectively manages pediatric gastroesophageal reflux, achieving symptom control in nearly 90% of patients and reducing esophagitis. However, 15% of cases fail, particularly those with underlying disorders like esophageal atresia.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes Research
Background:
- Gastroesophageal reflux (GER) is common in children, often requiring surgical intervention when medical management fails.
- Fundoplication is a primary surgical treatment for severe pediatric GER, aiming to restore the anti-reflux barrier.
- Assessing long-term outcomes and identifying failure predictors is crucial for optimizing surgical strategies.
Purpose of the Study:
- To evaluate the clinical and endoscopic outcomes of fundoplication in pediatric patients with gastroesophageal reflux.
- To identify factors associated with treatment failure and complications after fundoplication.
Main Methods:
- Retrospective review of 279 pediatric patients undergoing 300 fundoplications (1991-2014).
- Assessment of underlying disorders, clinical/endoscopic findings, imaging, pH monitoring, and surgical techniques.
- Analysis of fundoplication patency, symptom control, esophagitis rates, complications, redo operations, and failure predictors.
Main Results:
- Symptom control was achieved in 87% of patients, with a significant decrease in esophagitis rates (65% to 29%).
- Fundoplication failed in 15% of patients; risk factors included underlying disorders (OR=3.1), esophageal atresia (OR=3.9), and hiatoplasty (OR=2.6).
- Mortality was low (0.3%), but 32% of redo-fundoplications also failed.
Conclusions:
- Fundoplication is effective for pediatric GER, significantly improving symptoms and esophagitis.
- Underlying disorders, particularly esophageal atresia and the use of hiatoplasty, are associated with higher failure rates.
- Careful patient selection and surgical technique are important to minimize failure risks in this complex pediatric population.
Purpose:
Clinical and endoscopic assessment of the outcome after fundoplication for pediatric gastroesophageal reflux.
Basic Procedures:
Hospital records of 279 consecutive patients who underwent fundoplication for gastroesophageal reflux from 1991 to 2014 were reviewed. Underlying disorders, clinical and endoscopic findings, imaging studies, pH monitoring, and surgical technique were assessed. Main outcome measures were patency of fundoplication, control of symptoms and esophagitis, complications, redo operations, and predictive factors of failures.
Main Results:
A total of 279 patients underwent 300 fundoplications (277 primaries and 23 redos). Underlying disorders in 217 (72%) patients included neurological impairment (28%) and esophageal atresia (22%). Indications for fundoplication included recalcitrant gastroesophageal reflux symptoms (44%), failure to thrive (22%), respiratory symptoms (15%), esophageal anastomotic stricture (4%), apneic spells (2%), and regurgitation (2%). Preoperative endoscopy was performed in 92% and pH monitoring in 49% of patients. Median age at primary fundoplication was 2.2 ((IQR = 0.5-7.5)) years. Fundoplication was open in 205 (74%; Nissen n = 63, Boix-Ochoa n = 97, Toupet n = 39, and other n = 6), laparoscopic in 72 (24%; Nissen n = 67 and Toupet n = 5), and included hiatoplasty in 73%. Clinical follow-up was a median of 3.9 (IQR = 1.2-9.9) years. Mortality related to surgery was 0.3%. Symptom control was achieved in 87% of patients, and esophagitis rate decreased from 65% to 29% (p < 0.001). Fundoplication failed in 41 (15%) patients. Failure was predicted by esophageal atresia risk ratio = 3.9 (95% confidence interval = 1.3-11, p = 0.01), any underlying disorder risk ratio = 3.1 (95% confidence interval = 1.1-9.1, p = 0.04), and hiatoplasty risk ratio = 2.6 (95% confidence interval = 1.1-6.6, p = 0.03). Of the 23 redo-fundoplications, 32% failed.
Conclusion:
The majority of patients who underwent fundoplication had an underlying disorder. Primary fundoplication provided control of symptoms in almost 90% of patients and also reduced the rate of esophagitis. Failure of primary fundoplication occurred in 15% of patients, and an underlying disorder, esophageal atresia, and hiatoplasty increased the risk of failure.
Related Concept Videos
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:26Endoscopic Procedures V: ERCP
Patient...