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Published on: September 22, 2023
Current issues of gastro-oesophageal reflux disease surgical treatment in children
Nurlan Nurkinovich Akhparov1, Riza Boranbayeva2, Saule Bakhtyarovna Suleimanova1
1Department of Surgery, The Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan.
Insights
Gastro-oesophageal reflux (GER) disease in children often requires surgery. Surgical approaches like Nissen and Thall fundoplication are effective, with outcomes influenced by individual patient factors and surgical technique.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Gastro-oesophageal reflux (GER) disease is a common pediatric condition impacting quality of life.
- It presents with various complications including pneumonia and neurological issues.
- Surgical intervention is often necessary for persistent or severe cases.
Purpose of the Study:
- To analyze surgical interventions for GER disease in children.
- To evaluate the outcomes and complications of different surgical procedures.
- To emphasize the importance of individualized treatment approaches.
Main Methods:
- Retrospective analysis of 134 pediatric patients hospitalized for GER disease between 2008 and 2019.
- Surgical procedures included Nissen and Thall oesophagofundoplication, with and without gastrostomy and pyloroplasty.
- Laparoscopic Nissen fundoplication and Boerema gastropexy were also performed.
Main Results:
- 107 patients underwent surgery, with Nissen fundoplication (38%) and Thall fundoplication (45%) being most common.
- Complications included gastric distress syndrome (3.7%) and dumping syndrome (1.9%).
- Gastric distress was more frequent in patients without pyloroplasty, sometimes requiring further intervention.
Conclusions:
- Surgical management of pediatric GER disease involves various effective techniques.
- Individualized patient assessment is crucial for selecting the optimal surgical approach.
- Careful consideration of procedures like pyloroplasty can mitigate complications.
Abstract:
Gastro-oesophageal reflux (GER) disease is one of the most common diseases amongst 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. From 2008 to 2019, 134 patients aging from 6 months to 12 years were hospitalised 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 GER 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 oesophagus with its atresia. One hundred and seven (79.8%) patients underwent surgery. Nissen oesophagofundoplication 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 oesophagofundoplication was used in 16 (15%) cases. Thall oesophagofundoplication was performed in 48 (45%) patients, while in two (2%) cases, Boerema gastropexy was conducted. 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. 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.
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