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Complications and reoperation after Nissen fundoplication in childhood
Insights
Nissen fundoplication effectively treated gastroesophageal reflux in 92% of pediatric patients. However, 16% experienced complications, with reoperation needed for 8.8%, particularly in neurologically impaired children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux is a common condition in children.
- Nissen fundoplication is a surgical option for managing severe gastroesophageal reflux disease.
Purpose of the Study:
- To evaluate the outcomes and complications of Nissen fundoplication in pediatric patients.
- To assess the success rate of primary and secondary antireflux surgeries.
Main Methods:
- Retrospective review of 429 pediatric Nissen fundoplications over 10 years.
- Analysis of postoperative complications, mortality, and long-term outcomes.
- Evaluation of factors influencing reoperation rates and success of second procedures.
Main Results:
- 92% of patients achieved symptom control after initial fundoplication.
- 16% experienced postoperative complications, including wrap herniation, obstruction, and stricture.
- Mortality rate was 0.9%, primarily in neurologically impaired patients.
- 8.8% required reoperation, often due to wrap breakdown or herniation, especially in neurologically impaired children.
- A second fundoplication was successful in 92% of cases.
Conclusions:
- Nissen fundoplication is a highly effective treatment for pediatric gastroesophageal reflux.
- Complication rates, particularly wrap integrity issues, necessitate careful patient selection and surgical technique.
- Neurologically impaired children represent a higher-risk group for complications and reoperation.
Abstract:
Over a 10 year period, 429 Nissen fundoplications were performed on children with gastroesophageal reflux. Postoperative complications occurred in 69 children (16 percent), including wrap herniation or breakdown in 29; postoperative bowel obstruction in 18; stricture in 10; intraabdominal abscess and enterocutaneous fistula in 3 patients each; and wound infection, wound dehiscence, and inadvertent splenectomy in 2 patients each. The postoperative mortality rate was 0.9 percent (4 of 429 patients) and was related to sepsis in 1 patient, a metabolic disorder in 1 patient, and underlying pulmonary disease in 2 patients. All four patients were neurologically impaired. Fundoplication successfully controlled symptoms of gastroesophageal reflux in 395 children (92 percent) over a follow-up period ranging from 6 months to 10 years. Thirty-eight patients (8.8 percent) required a second antireflux operation because of recurrent symptoms. Twenty-nine patients had severe neurologic impairment (76 percent), 5 had associated congenital malformations (13 percent), and 3 had significant pulmonary problems (8 percent). Only one child requiring reoperation was considered otherwise normal. Indications for reoperation included wrap breakdown or herniation (28 patients), stricture (6 patients), and inadequate wrap (4 patients). Twenty-four of 28 children with wrap herniation or breakdown had neurologic impairment. A second fundoplication was successful in 35 of 38 patients (92 percent). A second procedure failed in three children, who required subsequent resection and colon interposition.