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Fundoplication in 160 children under 2 years of age
N L Kazerooni1, J VanCamp, R B Hirschl
1Section of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI.
Insights
Fundoplication surgery effectively resolved symptoms in most young children with gastroesophageal reflux (GER). However, 16% required a second procedure for recurrent reflux, with surgery type and patient factors not impacting success.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Reflux Management
Background:
- Gastroesophageal reflux (GER) is common in infants and young children.
- Surgical intervention, such as fundoplication, is considered for severe or refractory cases.
- Limited data exists on the long-term outcomes of fundoplication in very young children.
Purpose of the Study:
- To analyze the natural history and outcomes of gastric fundoplication (GF) in children under two years of age.
- To evaluate the efficacy of GF in resolving GER-related symptoms and complications.
- To identify factors influencing the success or failure of fundoplication in this pediatric population.
Main Methods:
- Retrospective chart review of 160 children who underwent GF before age 2 (1974-1992).
- Documentation of GER via upper GI series and/or 24-hour pH probe.
- Assessment of clinical resolution of failure to thrive (FTT), emesis (Ems), aspiration pneumonia (Asp), and need for re-operation.
Main Results:
- Overall clinical resolution of symptoms was achieved in 71% of patients post-fundoplication.
- High success rates were observed for FTT (87%), Ems (92%), and Asp (70%).
- 16% of patients required a second fundoplication due to recurrent reflux; GF type, age, esophageal atresia, or neurological impairment did not significantly affect outcomes.
Conclusions:
- Gastric fundoplication is an effective treatment for GER in young children, leading to significant symptom resolution.
- Recurrent reflux requiring re-operation occurs in a notable proportion of cases.
- The study did not find significant differences in GF success based on surgical technique, patient age, or comorbidities like EA or NI.
Abstract:
The natural history of fundoplication in young children with gastroesophageal reflux (GER) had not been analyzed previously. The authors reviewed the charts of 160 children who underwent gastric fundoplication (GF) before the age of 2 years (mean age [+/- SD], 9 +/- 7 months; range, 1 week to 2 years), from 1974 to 1992. Reflux was documented by upper gastrointestinal series in 124 patients, by 24-hour pH probe monitor in 98 patients, and by both in 68 patients. Clinical indications for GF included failure to thrive (FTT) in 68%, emesis (Ems) in 58%, and aspiration pneumonia (Asp) in 53%. Neurological impairment (NI) was present in 47% of all patients, and 13% had esophageal atresia (EA). The type of GF used was a Nissen fundoplication in 79% and an anterior fundoplication (AF) in 21%. Of the 160 patients, 24 (15%) died of unrelated causes. Of the remaining 136, follow-up of at least 2 years was obtained for 96 (mean follow-up period, 5.3 +/- 3.0 years; range, 2 to 15 years). Clinical resolution of symptoms/findings after GF occurred in 87% of children with FTT, 92% with Ems, 70% with Asp, and 71% overall. A second fundoplication was required for 15 children (16%) because of documented recurrent reflux. The type of GF, the age of the patient, and the presence of EA or NI did not significantly affect the success of GF.(ABSTRACT TRUNCATED AT 250 WORDS)