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Published on: September 22, 2023
Five-Year Outcome of Laparoscopic Fundoplication in Pediatric GERD Patients: a Multicenter, Prospective Cohort Study
Rebecca K Stellato1, Nadia Colmer2, Stefaan H A Tytgat2
1Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Internal mail no Str. 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. r.k.stellato@umcutrecht.nl.
Insights
Laparoscopic anti-reflux surgery (LARS) effectively treats pediatric GERD long-term. While symptoms improve, some patients experience recurrence, and quality of life may decrease over time.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Gastroesophageal reflux disease (GERD) is prevalent in children, often managed with medication.
- Laparoscopic anti-reflux surgery (LARS) is an option for refractory GERD.
- Long-term outcomes of LARS in pediatric patients are not well-documented.
Purpose of the Study:
- To evaluate the long-term efficacy and effects of LARS in children with GERD.
- To assess symptom severity and health-related quality of life (HRQoL) up to 5 years post-surgery.
Main Methods:
- Prospective, multicenter study involving 25 pediatric patients undergoing laparoscopic fundoplication.
- Symptom assessment using a gastroesophageal reflux symptom questionnaire.
- HRQoL evaluation using the PedsQL™ at 3 months, and 1, 2, and 5 years postoperatively.
Main Results:
- Significant improvement in reflux symptom severity was maintained at 5 years post-LARS (p < 0.0001).
- 26% of patients reported moderate to severe symptoms at 5 years; dysphagia occurred in 13%.
- HRQoL showed an initial increase but declined over time, remaining higher than preoperative levels.
Conclusions:
- LARS is effective for therapy-resistant pediatric GERD, with sustained symptom improvement at 5 years.
- A gradual decrease in symptom-free patients and a decline in HRQoL over time were observed.
- LARS offers long-term benefits, but monitoring for symptom recurrence and HRQoL changes is important.
Background:
Gastroesophageal reflux disease (GERD) is a common disease in children. When drug treatment fails, laparoscopic anti-reflux surgery (LARS) is considered. Short-term follow-up studies report high success rates; however, few studies report long-term results. The aim of this study was to describe the long-term effects of LARS in pediatric patients.
Methods:
A prospective, multicenter study of 25 laparoscopic fundoplication patients was performed. At 3 months and 1, 2, and 5 years postoperatively, patients and caregivers were asked to complete the gastroesophageal reflux symptom questionnaire to assess symptoms and the PedsQL™ to assess health-related quality of life (HRQoL).
Results:
Reflux symptom severity was still significantly improved 5 years after LARS compared with preoperative levels (p < 0.0001). However, 26% of patients reported moderate or severe reflux symptoms. Dysphagia was reported in 13% of patients 5 years after LARS and was more common in children with neurologic impairment and children who underwent a Nissen procedure. The increase in HRQoL 3 months postoperatively appears to decline over time: 5 years after surgery, HRQoL was lower, though not significantly, than 3 months postoperatively. HRQoL at 5 years was still higher, though also not significantly, than preoperative levels. The presence of reflux symptoms after surgery was not significantly associated with lower HRQoL.
Conclusions:
LARS is effective for therapy-resistant GERD in children. Five years after surgery, reflux symptoms are still improved. However, we observed a decline in symptom-free patients over time. The initial increase in HRQoL shortly after LARS appears to decline over time.
Trial Registration:
Dutch national trial registry Identifier: 2934 ( www.trialregister.nl ).
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