Gastroesophageal reflux associated with large diaphragmatic hernias

Related Experiment Video

Updated: Oct 23, 2026

Surgical Models of Gastroesophageal Reflux with Mice
05:19

Surgical Models of Gastroesophageal Reflux with Mice

Published on: August 25, 2015

D L Sigalet1, L T Nguyen, V Adolph

  • 1Department of Surgery, University of Alberta, Edmonton, Canada.

Journal of Pediatric Surgery
|September 1, 1994
PubMed

Insights

Infants with large congenital diaphragmatic hernias (CDH) requiring ECMO support can develop severe gastroesophageal reflux. Aggressive surgical intervention, including Nissen fundoplication and pyloroplasty, is recommended when medical management fails.

Area of Science:

  • Pediatric Surgery
  • Neonatal Intensive Care
  • Gastroenterology

Background:

  • Extracorporeal membrane oxygenation (ECMO) has improved survival for infants with congenital diaphragmatic hernias (CDH).
  • Survivors of severe CDH often have larger defects, pulmonary hypoplasia, and associated comorbidities.
  • Gastroesophageal reflux (GER) is a known complication in CDH patients.

Observation:

  • This study focuses on the experience with GER in CDH infants requiring ECMO.
  • GER in this cohort was observed to be severe and intractable, unlike previous reports.
  • Associated gastric dysmotility appeared to be a contributing factor to the severe reflux.

Findings:

  • Medical therapy and anterior fundoplication were ineffective in managing GER in these patients.
  • Nissen fundoplication combined with pyloroplasty successfully controlled reflux.
  • Surgical intervention allowed for successful gastric feeding in infants with severe GER post-CDH repair.

Implications:

  • Aggressive surgical management, including early Nissen fundoplication and pyloroplasty, should be considered for refractory GER in CDH survivors.
  • Insertion of a gastric feeding tube during surgical repair may be beneficial.
  • This approach can improve outcomes and enable enteral feeding in complex pediatric surgical cases.

More Related Videos

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh10:52

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh

Published on: September 11, 2021

Technical Considerations and Approach to Redo Foregut Surgery04:14

Technical Considerations and Approach to Redo Foregut Surgery

Published on: September 22, 2023

Related Concept Videos

Gastroesophageal Reflux Disease I: Meaning and Pathophysiology01:29

Gastroesophageal Reflux Disease I: Meaning and Pathophysiology

Gastroesophageal Reflux Disease (GERD) involves the recurrent backflow of the stomach or duodenal contents into the esophagus, leading to troublesome symptoms and potential esophageal mucosal damage. Although GERD is often referred to as a disease, it is more accurately described as a syndrome, as it encompasses a range of symptoms and complications rather than a singular pathological entity, impacting a large number of individuals as the most prevalent upper gastrointestinal problem. Roughly...
Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

Gastroesophageal Reflux Disease II: Clinical Features and Management

Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails...
Esophageal Achalasia01:27

Esophageal Achalasia

Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide (VIP)...
Gastroesophageal Reflux Disease01:25

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is the backward flow of stomach contents (acid, pepsin, or bile) into the esophagus, causing mucosal inflammation known as esophagitis. It results from failure of antireflux mechanisms, mainly the lower esophageal sphincter (LES), influenced by mechanical and physiological factors.Etiology and Risk FactorsGERD develops when LES function is weakened or when intra-abdominal pressure increases. Risk factors include aging, obesity, and sliding hiatal hernia,...
Hiatal Hernia01:25

Hiatal Hernia

A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or heavy...