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Long-term effect of Nissen fundoplication in young puppies
Insights
Nissen fundoplication, a surgery for acid reflux in children, was studied in puppies. The procedure did not impact esophageal growth or overall development, suggesting it is safe for young patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Comparative Medicine
Background:
- Nissen fundoplication is a common surgical treatment for gastroesophageal reflux in pediatric patients.
- Concerns exist regarding potential long-term esophageal constriction and obstruction following Nissen fundoplication in infants.
Purpose of the Study:
- To evaluate the long-term effects of Nissen fundoplication on the distal esophagus and overall growth in young animals.
Main Methods:
- A prospective study involving 20 puppies (1-2 weeks old) undergoing either Nissen fundoplication or a sham operation.
- Esophageal manometry and barium studies were performed preoperatively and postoperatively.
- Esophageal diameter was measured during surgery, and animals were monitored for up to 4 years.
Main Results:
- No significant differences were observed in esophageal diameter between the Nissen fundoplication group and the control group at autopsy.
- Barium studies revealed no esophageal dilation in the fundoplicated group compared to controls.
- Both groups exhibited normal growth, with no differences in body weight or linear growth at sacrifice.
Conclusions:
- Nissen fundoplication does not appear to impede the growth of the distal esophagus in young puppies.
- The surgical procedure does not adversely affect overall body weight or linear growth in the long term.
Abstract:
Nissen fundoplication effectively prevents gastroesophageal reflux in children. However, the long-term effect of this operation on the distal esophagus of infants and children is unknown, and a fear has been expressed that wrap-around operations on a small infant esophagus would constrict growth of the lower esophagus and cause late partial obstruction. In this study, the long-term effect of Nissen fundoplication was evaluated. There were 20, 1-2-wk-old puppies operated upon; 10 underwent Nissen fundoplication and 10 had only a sham operation to serve as a control group. Three puppies in each group had esophageal manometry and barium studies of the esophagus preoperatively and at various times postoperatively. The diameter of the esophagus was measured in all dogs during the operation. All fundoplications were done with a #20F dilator inside the esophagus. Two dogs in each group were sacrificed at 1, 2, and 3 yr of age, and the remainder were sacrificed at 4 yr of age. At autopsy, there was no difference in the diameter of the esophagus in the dogs with Nissen fundoplication compared with the sham-operated dogs. Barium studies in the fundoplicated group showed no dilation of the esophagus compared to the sham-operated group. Both groups grew normally and there were no differences in weight at the time of sacrifice. It seems that Nissen fundoplication does not affect growth of the distal esophagus in young puppies, and that body weight and linear growth are not altered by this operation.