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Long-term follow-up of Nissen fundoplication
J Mira-Navarro1, F Bayle-Bastos, M Frieyro-Segui
1Servicio de Cirugia Infantil, Hospital General de Alicante, España.
Insights
Nissen fundoplication is effective for pediatric gastroesophageal reflux. Most children remain asymptomatic after surgery, even with cuff displacement, but reoperation is needed if the cuff is disorganized and herniates into the chest.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Gastroesophageal reflux is a common condition in children.
- Nissen fundoplication is a surgical option for refractory cases.
- Understanding long-term outcomes and complications is crucial.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of Nissen fundoplication in children.
- To assess the impact of cuff position and integrity on patient outcomes.
- To identify predictors for reoperation.
Main Methods:
- Retrospective study of 68 children under 7 years old.
- Abdominal approach Nissen operation.
- Postoperative follow-up of 4-14 years.
- Classification based on radiological appearance and cuff site.
Main Results:
- Group 1 (intraabdominal, competent cuff): 40 patients, asymptomatic.
- Group 2 (partially intrathoracic, competent cuff): 22 patients, asymptomatic.
- 92% of patients in Groups 1 & 2 were asymptomatic with no reoperations.
- Group 3 (disorganized, herniated cuff): 6 patients, symptomatic, required reoperation.
Conclusions:
- Nissen fundoplication is effective for pediatric gastroesophageal reflux.
- Cuff displacement is common but often doesn't affect competence.
- Reoperation is indicated for cuff disorganization with thoracic herniation and symptom recurrence.
Abstract:
A study of 68 children under 7 years of age, who had had an abdominal approach Nissen operation, with a postoperative follow-up of between 4 and 14 years, is presented. The patients were classified into three groups, according to radiological appearance and cuff site. In the first group (40 patients) the cuff was intraabdominal and competent; in the second group (22 patients) the cuff was partially displaced into the thorax and was competent. 92% of the patients of these groups are currently asymptomatic and none required reoperation. In the third group (6 patients), there was disorganization of the cuff, together with its displacement into the chest, recurrence of symptoms and the authors recommended reoperation. Nissen's operation is an effective treatment for gastrooesophageal reflux in children unresponsive to medical treatment. Although displacement occurs frequently, valve competence is unaffected except in those where the cuff has disappeared and there is herniation into the thorax in which case reoperation is necessary.