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Results and complications of surgery for gastro-oesophageal reflux
Insights
Antireflux surgery in children achieved 92% success but had complications, especially in those with mental retardation or esophageal strictures. Earlier surgical referral may prevent adverse outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Gastroesophageal reflux disease (GERD) is common in children.
- Antireflux surgery is a treatment option for severe GERD.
- Complications and success rates vary, particularly in special populations.
Purpose of the Study:
- To evaluate the outcomes of antireflux surgery in children.
- To identify risk factors for complications.
- To assess the impact of patient characteristics on surgical success.
Main Methods:
- Retrospective study of 106 children undergoing antireflux surgery.
- Analysis of patient demographics, pre-existing conditions, and surgical outcomes.
- Categorization of complications and their management.
Main Results:
- Overall success rate was 92%, with 20 patients (19%) requiring reoperation.
- Common complications included fundoplication prolapse (7 patients), intestinal obstruction (5), and esophageal strictures (5).
- Higher complication rates were observed in children with severe mental retardation and pre-existing esophageal strictures.
Conclusions:
- Antireflux surgery can be successful in children but carries risks.
- Severe mental retardation and esophageal strictures are associated with increased postoperative complications.
- Delayed surgical referral in these high-risk groups may contribute to poorer outcomes, suggesting earlier intervention is beneficial.
Abstract:
One hundred and six children undergoing antireflux surgery were studied; 41 were severely mentally retarded and 29 had reflux strictures. Although the eventual rate of success was 92%, 20 patients developed complications that required a second operation. Prolapse of the fundoplication into the mediastinum was the commonest complication (in seven patients), followed by intestinal obstruction (in five), and intractable fibrous oesophageal strictures (in five). The incidence of postoperative complications was highest in patients with mental retardation or oesophageal strictures. Referral of these patients for operation was invariably delayed, and earlier referral may have avoided many of the complications.