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Postoperative small bowel obstruction in infants and children: a problem following Nissen fundoplication
Insights
Nissen fundoplication surgery in children has a significantly higher rate of causing small bowel obstruction compared to other antireflux operations. This serious complication requires reoperation in a notable percentage of cases.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Complications
Background:
- Postoperative small bowel obstruction is a serious complication following antireflux surgery in infants.
- Infants cannot communicate symptoms and are unable to vomit, complicating diagnosis.
Purpose of the Study:
- To review the operative rate of small bowel obstruction after various antireflux operations in children.
- To compare the incidence of small bowel obstruction following Nissen fundoplication with other antireflux procedures and major laparotomies.
Main Methods:
- Retrospective review of antireflux operations (Nissen, Hill, Thal, Boerema) performed between January 1977 and July 1984.
- Analysis of reoperation rates for small bowel obstruction within two years post-surgery.
- Comparison of Nissen fundoplication complication rates with other procedures and major laparotomies.
Main Results:
- Eighteen patients (17 Nissen, 1 Hill) required reoperation for small bowel obstruction.
- Reoperation for small bowel obstruction occurred in 6.1% of Nissen fundoplications versus 0.9% for other major laparotomies (P < 0.001).
- Estimated incidence of adhesive small bowel obstruction: 5.5% for Nissen, 0.9% for modified Thal, and 0.8% for Boerema.
Conclusions:
- Nissen fundoplication is associated with a significantly higher rate of reoperation for small bowel obstruction in children.
- The incidence of postoperative adhesive small bowel obstruction is notably higher after Nissen fundoplication compared to other antireflux surgeries.
- Clinical findings of abdominal distention and decreased bowel movements were consistent in affected children.
Abstract:
A serious consequence of antireflux surgery is postoperative small bowel obstruction in an infant who cannot speak and has been rendered unable to vomit. We reviewed the operative rate for small bowel obstruction following all antireflux operations (210 Nissen fundoplications, 16 Hill fundoplications, 12 modified Thal fundoplications, and 3 Boerema anterior gastropexies) performed on children at our institution between January 1977 and July 1984. Eighteen patients (17 Nissen fundoplications, one Hill fundoplication) were operated upon for small bowel obstruction within two years after the primary operation. The most consistent clinical findings in these children were abdominal distention and a decreased frequency of bowel movements. For operations performed between January 1982 and July 1984, reoperation for small bowel obstruction was needed in 6.1% (6/99) of children following Nissen fundoplication as compared to 0.9% (6/649), P less than 0.001) of children following other major laparotomies. A combination of our experience with that reported by others suggests an estimated incidence of postoperative adhesive small bowel obstruction of 5.5% (24/436) for Nissen fundoplication, 0.9% (3/347) for modified Thal fundoplication, and 0.8% (1/126) for Boerema anterior gastropexy. The performance of a Nissen fundoplication has led to a significant rate of reoperation for small bowel obstruction compared with other major laparotomies and antireflux operations performed in children.