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Operative treatment of gastroesophageal reflux in low birth weight infants
V L Rowe1, M Krishnamoorthy, H Applebaum
1Kaiser Permanente Medical Center, Los Angeles, California, USA.
Insights
Nissen fundoplication surgery for symptomatic gastroesophageal reflux (GER) is safe and effective in low birth weight infants. This surgical correction achieved symptom resolution in 91% of patients with no intraoperative complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Symptomatic gastroesophageal reflux (GER) is commonly treated surgically in older infants.
- Surgical repair of GER in very small, low birth weight infants is less common due to perceived difficulties.
Purpose of the Study:
- To evaluate the safety and efficacy of Nissen fundoplication for symptomatic GER in low birth weight (LBW) infants.
Main Methods:
- Retrospective review of 21 LBW infants (< or = 2500 grams) undergoing Nissen fundoplication for symptomatic GER.
- All patients had failed medical management prior to surgery.
- Follow-up ranged from 1 month to 5 years.
Main Results:
- No intraoperative complications were reported.
- Symptom resolution was achieved in 91% of the infants.
- Key technical factors for success included appropriate dilators, division of short gastric vessels, and a loose 360-degree wrap.
Conclusions:
- Nissen fundoplication can be performed safely and effectively in small LBW infants with symptomatic GER.
- Careful surgical technique is crucial for successful outcomes in this population.
Abstract:
Operative correction of symptomatic gastroesophageal reflux (GER) has been used frequently and successfully in both children and larger infants for many years. In contrast, surgical repair of GER has been applied relatively sparingly in very small infants because of perceived technical and postoperative difficulties. We retrospectively reviewed our experience with Nissen fundoplications performed for symptomatic GER in low birth weight (LBW) infants ( < or = 2500 grams the time of surgery). Twenty-one consecutive cases from 1988 to 1993 were evaluated. At the time of surgery, the average age was 9.1 weeks and the average weight was 2100 grams (range, 1220 to 2500 grams). All infants had failed a trial of medical management. Follow-up from 1 month to 5 years showed no intraoperative complications and resolution of symptoms in 91 per cent of our patients. Technical factors found to enhance the success of the operative repairs included appropriately sized dilators, division of the short gastric vessels, and a loose 360-degree wrap. With suitable technique, the surgical management of symptomatic GER can be performed safely in small infants.