Postfundoplication retching: Strategies for management

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Neurodisability Research

Background:

• Retching is a frequent complication after antireflux surgery in children, particularly those with neurodevelopmental disorders.
• Retching is a component of the emetic reflex, not a symptom of gastroesophageal reflux disease (GERD), and can lead to surgical wrap disruption.
• The presence of retching indicates nausea and is a distressing symptom that requires dedicated treatment.

Purpose of the Study:

• To develop a management framework for postoperative retching targeting the emetic reflex.
• To evaluate the influence of different antireflux procedures on the occurrence of retching.
• To identify children at risk for postoperative retching prior to surgery.

Main Methods:

• A structured approach was created to manage postoperative retching by addressing various elements of the emetic reflex.
• Consideration was given to how different antireflux surgical techniques affect the incidence of retching.
• Strategies included dietary modifications, antiemetic medications, and pro-motility agents.

Main Results:

• The study framework provides strategies for managing postoperative retching, including dietary adjustments and pharmacological interventions.
• Fundoplication is identified as an inappropriate procedure for children at risk of retching, as it does not address the underlying emetic reflex and may worsen symptoms or cause wrap disruption.
• Alternative management strategies are recommended for symptom control in these patients.

Conclusions:

• Children at risk for postoperative retching can be identified preoperatively.
• Fundoplication should be avoided in children prone to retching due to its ineffectiveness for their symptoms and risk of complications.
• Management should focus on the emetic reflex, utilizing antiemetics, motility agents, and potentially neuromodulation, rather than solely on GERD.