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[Diagnosis and therapy of dumping syndrome following Nissen fundoplication with reference to pathogenetic aspects]
1Chirurgische Klinik, Universitäts-Kinderspital Zürich.
Insights
Infants undergoing Nissen fundoplication may develop dumping syndrome, characterized by feeding refusal and metabolic disturbances. Early diagnosis and dietary management, such as a dumping diet, are crucial for recovery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Endocrinology
Context:
- Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease.
- Postoperative complications can significantly impact infant recovery and well-being.
Purpose:
- To report the incidence and characteristics of dumping syndrome in infants following Nissen fundoplication.
- To highlight the diagnostic criteria and management strategies for this condition.
Summary:
- Seven out of 27 infants developed dumping syndrome post-Nissen fundoplication, presenting with irritability, pallor, sweating, tachycardia, lethargy, diarrhea, and vomiting.
- Diagnosis was confirmed by postprandial hyperglycemia with hyperinsulinemia leading to reactive hypoglycemia; elevated HbA1c indicated recurrent hyperglycemia in some.
- Most cases resolved with a specialized 'dumping diet' replacing simple carbohydrates with uncooked starch, though one infant required long-term enteral nutrition.
Impact:
- Complete feeding refusal is an early indicator of dumping syndrome after Nissen fundoplication.
- Prompt recognition and exclusion of dumping syndrome are essential for appropriate infant care.
- Effective management, including dietary modification, can prevent prolonged symptoms and improve outcomes.
Abstract:
Between 1982 and 1987 27 Nissen's fundoplications were carried out in our institution. Postoperatively 7 infants showed a typical dumping syndrome. The symptoms were irritability, pallor, sweating, tachycardia, lethargy, diarrhoea and vomiting. In all cases an absolute refusal of feeding was observed. The diagnosis was confirmed by a typical early postprandial hyperglycaemia with hyperinsulinaemia leading to a reactive hypoglycaemia. Additionally, we were able to demonstrate an increased HbA1c as an expression of recurrent hyperglycaemias in 3 infants. In 6 infants the dumping syndrome was of short duration and the symptoms disappeared after application of a so-called dumping diet. In this diet the easily resorbable carbohydrates are replaced by uncooked starch. But in one case we were forced to use continuous enteral nutrition because of persistence of the symptoms 1 year after the Nissen fundoplication. Complete refusal of feeding is an early symptom of the dumping syndrome. If this symptom is observed after a Nissen's fundoplication, a dumping syndrome must be excluded.