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Published on: September 22, 2023
Short and long-term outcomes after pediatric redo fundoplication
Morten Kvello1, Charlotte K Knatten2, Thomas J Fyhn1
1Institute of Clinical Medicine, University of Oslo, Norway; Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway.
Insights
Redo fundoplication (RF) successfully treats recurrent gastroesophageal reflux disease (GERD) in children, with high patient and parental satisfaction despite some persistent symptoms. Long-term outcomes show RF is a viable option for managing complex GERD cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Recurrent gastroesophageal reflux disease (GERD) in children often necessitates surgical intervention.
- Redo fundoplication (RF) is the primary surgical approach for recurrent GERD, yet its outcomes are underreported.
- Assessing the efficacy and safety of RF is crucial for pediatric surgical practice.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of redo fundoplication (RF) in pediatric patients.
- To determine the recurrence rates and complication profiles following RF.
- To assess patient and parental satisfaction after RF for recurrent GERD.
Main Methods:
- A follow-up study was conducted on pediatric patients who underwent RF between 2002 and 2020.
- Data collection involved questionnaires for symptoms, side effects, and satisfaction, supplemented by retrospective chart review.
- The study included 24 out of 28 eligible patients, with a median follow-up of 9 years.
Main Results:
- The majority of patients (86%) were included in the follow-up, with 67% having neurological impairment.
- Indications for RF included recurrent GERD (n=18), herniated wrap (n=5), and slipped fundoplication (n=1).
- Early major complications occurred in 25% of patients. Recurrence after RF was observed in 21%, with 3 achieving symptom resolution. Common follow-up symptoms included stomach pain (37%) and flatulence (38%).
Conclusions:
- Redo fundoplication (RF) is an effective treatment for recurrent GERD in children following initial anti-reflux surgery.
- Despite potential complications and symptom recurrence, patient and parental satisfaction with RF remains high.
- RF demonstrates successful management of complex GERD cases in the pediatric population.
Background:
Redo fundoplication (RF) is the most common surgical treatment for recurrent gastroesophageal reflux disease (GERD) in children, but outcomes after RF are rarely reported. The aim of this study was to assess short- and long-term outcomes after RF in childhood.
Methods:
The study is a follow-up study of patients undergoing RF from 2002 to 2020 at a teriary care center. Patients/parents were sent questionnaires recording symptoms of recurrent GERD, troublesome side-effects and satisfaction. Retrospective chart review was also performed.
Results:
24/28 (86%) patients were included median 9 (1.6 months-17.7 years) years after RF. 16 (67%) had neurologic impairment. Indications for RF was recurrence of GERD (n = 18), discomfort or dysphagia from a herniated wrap (n = 5) and dysphagia from a slipped fundoplication (n = 1). Median operating time was 128 (95-250) min. Six (25%) patients experienced early major complications, of which two were gastrostomy related. Five (21%) patients experienced recurrence after RF. Three of these were symptom free at follow-up with medical treatment or re-RF. The most common symptom at follow-up was stomach pain (37%) and excessive flatulence (38%). 18/22 (95%) patients/parents would choose RF again, and 21/22 would recommend RF to someone in a similar situation.
Conclusions:
RF is successful in treating recurrent GERD after primary fundoplication, and patient/parental satisfaction is high.
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