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Gastroesophageal reflux in infants and children. Diagnosis and management
Insights
Surgical correction for gastroesophageal reflux (GER) in infants and children showed excellent or good results in most cases. Nissen fundoplication proved a safe and effective antireflux procedure with zero surgical mortality.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) poses significant challenges in infants and children, often presenting with failure to thrive, vomiting, and aspiration pneumonitis.
- Coexistent conditions such as brain damage (cerebral palsy), esophageal atresia, gastroschisis, and omphalocele repair complicate GER management.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical correction for gastroesophageal reflux (GER) in a pediatric population.
- To assess the outcomes of Nissen fundoplication and Hill repair in managing severe GER.
Main Methods:
- Retrospective analysis of 83 infants and children undergoing surgical correction for GER between 1973 and 1978.
- Surgical procedures included transabdominal Nissen fundoplication (80 cases) and Hill repair (3 cases).
- Diagnostic methods comprised barium roentgenography and pH monitoring.
Main Results:
- Surgical mortality was zero; five late deaths occurred. Excellent outcomes were achieved in 54 patients, good in 22, and poor in 7.
- Nissen fundoplication was effective in 76 of 83 cases.
- Preoperative esophageal strictures responded to dilation post-fundoplication in 10 of 12 patients.
Conclusions:
- Transabdominal Nissen fundoplication is a safe and effective surgical treatment for pediatric gastroesophageal reflux (GER).
- Surgical intervention can yield excellent or good results in the majority of pediatric patients with GER, even those with complex comorbidities.
- Effective management of GER in children can improve outcomes and address complications like failure to thrive and aspiration pneumonitis.
Abstract:
Eighty-three infants and children underwent surgical correction of gastroesophageal reflux (GER) from 1973 to 1978. Fifty-four patients had coexistent brain damage (most commonly due to cerebral palsy), eight were previously treated for esophageal atresia, and four had gastroschisis or omphalocele repair. Clinical presentation included failure to thrive in 64 patients, vomiting in 59, and recurrent bouts of aspiration pneumonitis in 43. Barium roentgenography showed GER in 61 patients, whereas additional tests (particularly pH monitoring) were required for detection of GER in 22 patients. After failure of medical management, transabdominal Nissen fundoplication was performed in 80 cases and a Hill repair in three cases. The surgical mortality was zero, but there were five late deaths. Results were considered excellent in 54 patients, good in 22 patients, and poor in seven. Ten of 12 patients with preoperative stricture responded to dilation after fundoplication. Nissen fundoplication was a safe and effective antireflux procedure in 76 of the 83 cases.