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Surgical treatment of gastroesophageal reflux in infants
Insights
Surgical correction of severe gastroesophageal reflux in infants effectively resolves growth retardation and aspiration pneumonia. Early diagnosis and intervention are crucial for optimal outcomes in affected infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) is a significant concern in infants, potentially leading to severe complications.
- Indications for surgical intervention include severe growth retardation due to persistent vomiting and recurrent aspiration pneumonia.
Purpose of the Study:
- To evaluate the efficacy of surgical correction for pernicious gastroesophageal reflux in infants.
- To assess long-term outcomes and identify optimal therapeutic strategies.
Main Methods:
- Retrospective analysis of 31 infants undergoing surgery for GER.
- Diagnostic methods included barium swallow; hiatal hernia was noted in 17 patients.
- Surgical procedures included Allison repair, Nissen fundoplication, and gastropexy, with complementary pyloroplasty in 15 patients.
Main Results:
- Surgery successfully addressed growth retardation in 25 patients and aspiration pneumonia in six.
- No mortality was observed; 28 children were followed for 6 months to 8.5 years.
- All followed patients demonstrated excellent nutritional status and normal growth curves post-surgery.
Conclusions:
- Surgical intervention for severe gastroesophageal reflux in infants leads to excellent long-term growth and nutritional outcomes.
- Early diagnosis and prompt medical or surgical management are essential for infants with significant GER.
Abstract:
Thirty-one infants less than a year of age underwent surgery for correction of pernicious gastroesophageal reflux. Severe growth retardation from persistent vomiting was the single most important indication for surgery (25 patients). Recurrent aspiration penumonitis was another serious sequella of reflux and necessitated surgery in six patients. The diagnosis of gastroesophageal reflux was confirmed by barium swallow in all children, and in 17 a concomitant hiatal hernia was demonstrated. Patients selected for surgery were first treated conservatively unless they showed significant esophagitis or had a major portion of stomach in the chest. Babies treated early in the series had Allison repairs (7 transabdominal, 2 thoracic). Twenty-two subsequent patients have had Nissen fundoplication, and two gastropexies were performed. In 15 patients, significant gastric outlet obstruction required a complementary pyloroplasty. Four infants required a second surgical procedure because of recurrence. Two of the four patients had Nissen procedures with good results, one following a Boerema gastropexy and one following an Allison repair. The other two patients needed revision after fundoplication. There was no mortality. Twenty-eight children have been followed 6 months-8(1/2) years. All have excellent nutritional status and are following normal growth curves. Study of these patients indicates the need for early diagnosis and medical or surgical therapy for all infants with major gastroesophageal reflux.