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Laparoscopic fundoplication after oesophageal atresia repair
Maria-Grazia Scarpa1, Daniela Codrich1, Miriam Duci2
1Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy.
Insights
Laparoscopic fundoplication is a feasible treatment for gastro-esophageal reflux (GER) after esophageal atresia (EA) repair, though recurrence is possible. Infants under six months with comorbidities face higher risks.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Malformations
Background:
- Esophageal atresia (EA) is a rare congenital defect often associated with significant gastro-esophageal reflux (GER).
- GER unresponsive to medical management can lead to persistent complications into adulthood.
- Laparoscopic treatment for GER in pediatric patients with EA is an option, but recurrence rates are a concern.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of treating GER in patients who underwent EA repair.
- To assess the feasibility and complications associated with laparoscopic fundoplication (LF) for GER post-EA repair.
Main Methods:
- Retrospective analysis of 29 patients treated for EA and subsequent GER over 11 years.
- Detailed review of symptoms, surgical interventions (primarily LF), and follow-up outcomes.
- Identification of factors influencing surgical success and complications.
Main Results:
- 82.7% of EA patients exhibited GER symptoms; 58.6% underwent LF.
- No intra-operative complications, but 3/17 LF cases required conversion to open surgery.
- At follow-up, 35.3% healed, 47.1% showed GER improvement, and 11.8% had persistent GER.
Conclusions:
- Laparoscopic fundoplication is a viable treatment for GER following EA repair, despite potential recurrence.
- Infants under six months with additional conditions may have a higher failure rate and conversion risk.
- Extended follow-up and multicenter studies are recommended for comprehensive patient surveillance.
Background:
Esophageal atresia (EA) is a rare congenital malformation. A high incidence of GER unresponsive to medical management is noted with EA. Literature suggests that complications from GER can persist in adulthood. In paediatric age, laparoscopic treatment is a valid option even if recurrence rate is not negligible.
Aims And Objectives:
To evaluate our experience with gastro-esophageal reflux (GER) treatment after esophageal atresia (EA) repair.
Materials And Methods:
We retrospectively analysed 29 consecutive patients treated for EA at birth and studied for GER at our Institute in a period of 11 years.
Results:
24/29 (82,7%) cases had symptoms of reflux, 17/29 (58,6%) cases were treated with laparoscopic fundoplication (LF). Three infants were younger than 6 months and had apparent life threatening events (ALTE) condition as principal indication for surgery. No intra-operative complications occurred. 3/17 LF had open surgical conversion due to technical problems. 2/17 cases required a second operation. At the last follow-up: (1) 6/17 (35,3%) of patients healed after the last operation, (2) 8/17 (47,1%) have GER improvement (four still in medical treatment), (3) 2/17 (11,8%) have persistent GER, (4) 1/17 (5,9%) died for causes not related to antireflux surgery.
Conclusions:
According to literature and to our retrospective analysis, LF for GER after EA repair is feasible, even if recurrence risk is not negligible. Infants less than 6 months old with associated conditions (malformations, gastrostomy/jejunostomy) seem to have a higher failure rate with a greater risk of conversion. Longer follow-up and multicenter experiences would guarantee an adequate surveillance for patients with EA.
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