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Related Concept Videos

Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

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Robotic Myotomy and Partial Fundoplication for Achalasia
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Postfundoplication retching: Strategies for management.

Catherine A Richards1

  • 1Department of Paediatric Surgery, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.

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|May 16, 2020
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Summary

Postoperative retching in children, especially those with neurodisability, can cause surgical wrap breakdown. Management should focus on the emetic reflex, not gastroesophageal reflux, and avoid fundoplication in at-risk children.

Keywords:
Emetic reflexFundoplicationGastroesophageal refluxNeurodisabilityRetching treatmentVomiting reflex

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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.