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Fundoplication and pediatric esophageal manometry: actuarial analysis over 7 years
J C Opie1, H Chaye, G C Fraser
1Department of Cardiothoracic Surgery, BC Children's Hospital, Vancouver.
Insights
This study evaluated antireflux surgery in 61 children, finding a 7-year event-free survival of 62%. Manometric calibration yielded uniform results but no superiority over simpler techniques for preventing overly tight repairs.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) and its complications significantly impact children's health.
- Surgical intervention is often necessary for severe cases unresponsive to medical management.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of antireflux surgical procedures in pediatric patients.
- To assess the impact of manometric calibration on surgical outcomes.
Main Methods:
- A retrospective analysis of 73 antireflux surgeries performed on 61 children and infants.
- Esophageal manometry was utilized preoperatively, intraoperatively, and postoperatively.
- Actuarial methods were employed for long-term outcome evaluation over a 7-year follow-up period.
Main Results:
- Ninety-four percent patient survival was observed over the 7-year follow-up.
- The 7-year actuarial event-free survival rate was 62%, with all events occurring within 18 months.
- The 7-year actuarial failure rate for fundoplication was 24% using this technique.
Conclusions:
- Manometric calibration of antireflux procedures in pediatric patients leads to uniform results.
- This technique, while effective, did not demonstrate superiority over simpler methods using a rubber bougie to prevent overly tight repairs.
Abstract:
Sixty-one children and infants who had significant gastroesophageal reflux and associated complications underwent 73 surgical procedures to control the reflux. In order to evaluate the procedure, several esophageal manograms were obtained from each patient, before, during, and after the operation. Delayed follow-up reports were also obtained from follow-up visits, letter and telephone contact, in order to assess how the patient had progressed. The results were evaluated by actuarial analytic methods. Ninety-four percent of the patients remained alive over the 7-year follow-up period. At the completion of the seventh year, 62% of these patients (actuarially calculated) remained event free. All events occurred within 18 months of surgery. One patient could not be traced at long-term follow-up, which was therefore 92% complete. The 7-year actuarial probability of failure of the fundoplication at this institution is 24% when performed using this technique in these patients. These findings support that manometric calibration of the antireflux procedure tends to give uniform results in pediatric patients, but, compared with other published series has not proved to be superior to procedures that employ only a rubber bougie in the esophagus as an obdurator to prevent a repair that will be too tight.