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Current issues of GERD surgical treatment in children
Nurlan Nurkinovich Akhparov1, Riza Zulkarnaevna Boranbayeva2, Saule Bakhtyarovna Suleimanova1
1Department of Surgery, The Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Republic of Kazakhstan.
Insights
Pediatric gastroesophageal reflux disease (GERD) significantly impacts children
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Gastroesophageal reflux disease (GERD) is a prevalent chronic inflammatory condition in children.
- GERD significantly diminishes a child's quality of life and poses health risks.
- It affects children across all age groups, necessitating effective management strategies.
Purpose of the Study:
- To evaluate surgical interventions for pediatric GERD.
- To analyze the outcomes of different surgical techniques.
- To establish evidence-based indications for surgical treatment in pediatric GERD.
Main Methods:
- Retrospective analysis of 134 pediatric patients (6 months–12 years) hospitalized between 2008–2019.
- 107 patients underwent various surgical procedures, including Nissen and Thall esophagofundoplication, with or without gastrostomy and pyloroplasty.
- Laparoscopic Nissen esophagofundoplication was also employed.
Main Results:
- Immediate outcomes were assessed in 107 patients post-surgery.
- Gastric distress syndrome occurred in 3.7% of patients without pyloroplasty, requiring further intervention in 1.9%.
- Dumping syndrome was observed in 1.9% of patients.
Conclusions:
- Individualized patient assessment is crucial for determining surgical indications.
- Timely recognition of GERD's nature and extent guides treatment decisions.
- Surgical approaches should be tailored to each child's specific condition.
Introduction:
Gastroesophageal reflux disease is one of the most common diseases among a wide range of chronic inflammatory diseases of the gastrointestinal tract in children of all ages, significantly impairing the quality of life of the child and posing a serious threat to the health of the patient.
Materials And Methods:
From 2008 to 2019, 134 patients aging from 6 months to 12 years were hospitalized at the Scientific Center for Pediatrics and Pediatric Surgery, including 69 (51%) infants. Of them, 51 (38%) were the patients with persistent manifestations of regurgitation, despite an outpatient course of conservative therapy; 29 (22%) patients with recurrent reflux-associated pneumonia; also, 35 (26%) children with gastroesophageal reflux in the structure of the main pathology of the central nervous system, as well as 19 (14%) patients after surgery of the anastomosis of the esophagus with its atresia. One hundred and seven (79.8%) patients underwent surgery. Nissen esophagofundoplication was traditionally performed in 41 (38%) patients, in combination with Stamm gastrostomy in 14 (34%), with Mikulich pyloroplasty in 9 (22%), and in combination with gastrostomy and pyloroplasty in 12 (29%) children. Laparoscopic Nissen esophagofundoplication was used in 16 (15%). Thall esophagofundoplication was performed in 48 (45%) patients, whereas in two (2%) cases, Borema gastropexy was conducted.
Results:
The immediate results were studied in all 107 patients. Complications in the form of gastric distress syndrome were revealed in four (3.7%) patients who did not undergo pyloroplasty, which in two (1.9%) cases required additional surgery of the stomach draining, whereas in the other two (1.9%) patients, the distress syndrome was stopped conservatively. A dumping syndrome was identified in two (1.9%) patients.
Conclusion:
Timely recognition of the pathological process, its nature, and prevalence determines the indications for the use of various methods of operation, which are based on an individual approach to each patient.
