Fundoplication and pediatric esophageal manometry: actuarial analysis over 7 years

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.