Does Nissen fundoplication improve deglutition in children?

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Swallowing Disorders

Background:

• Gastroesophageal reflux (GER) can cause significant morbidity in children, including recurrent respiratory infections and swallowing dysfunction.
• Nissen fundoplication (NF) is a surgical procedure to treat GER, but its impact on deglutition requires further evaluation.

Purpose of the Study:

• To prospectively assess the effect of Nissen fundoplication (NF) on deglutition in pediatric patients.
• To evaluate changes in swallowing function, penetration-aspiration scale (PAS), and functional oral intake scale (FOIS) post-NF.

Main Methods:

• A prospective study included 23 children undergoing NF, evaluating demographic data, GER diagnostics (barium swallow, pH monitoring), and NF indications.
• Videofluoroscopy (VFS) was used pre- and post-operatively to assess PAS, FOIS, and esophageal functions.
• Clinical outcomes, including recurrent respiratory infections (RTI), were compared before and after surgery.

Main Results:

• NF effectively resolved GER in 95% of patients and significantly reduced the rate of RTI.
• Postoperative VFS showed a significant decrease in PAS scores, indicating reduced penetration and aspiration during swallowing.
• Functional oral intake scale (FOIS) scores significantly improved, demonstrating enhanced oral feeding capabilities in children after NF.

Conclusions:

• Nissen fundoplication is effective in improving deglutition and reducing aspiration in children with GER.
• The procedure leads to significant clinical benefits, including decreased recurrent respiratory infections and improved functional oral intake.
• While esophageal motility may not change, NF positively impacts swallowing safety and efficiency in the pediatric population.