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Evaluation of gastroesophageal reflux surgery in children
Insights
Operative management for gastroesophageal reflux in infants and children is effective. Surgical outcomes depend on the complexity of the condition, with different procedures suited for uncomplicated versus complex cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Gastroesophageal Reflux Disease
Background:
- Gastroesophageal reflux (GER) complications in pediatric patients often necessitate surgical intervention.
- Conservative management, including postural therapy, is typically attempted before surgery.
Purpose of the Study:
- To evaluate the efficacy of operative management for controlling symptoms of gastroesophageal reflux in infants and children.
- To compare surgical outcomes based on the complexity of GER complications.
Main Methods:
- A cohort of 55 infants and children with GER complications underwent operative management.
- Preoperative and postoperative assessments included X-ray fluoroscopy, esophageal manometry, and pH studies.
- Patients received a six-week trial of 60-degree elevation unless severe esophageal stricture was present.
Main Results:
- Boerema anterior gastropexy proved effective for uncomplicated GER cases.
- Nissen fundoplication was more effective for complex cases involving inflammation or operative changes.
- Good surgical results were not solely dependent on increased lower esophageal pressure post-operation.
Conclusions:
- Surgical intervention is a viable option for managing severe gastroesophageal reflux complications in pediatric patients.
- The choice of surgical procedure should be tailored to the specific clinical presentation, distinguishing between uncomplicated and complex GER disease.
Abstract:
Fifty-five infants and children with complications of gastroesophageal reflux required operative management for control of symptoms. All patients, except those with severe esophageal stricture, received a six-week trial with 60-degree constant elevation before an operation was considered necessary. The operation was performed to control (1) persistent vomiting, (2) vomiting with growth retardation, (3) esophagitis, (4) esophagitis with stricture, and (5) recurrent aspiration pneumonia. Preoperative and postoperative evaluation involved both X-ray fluoroscopy and esophageal manometry with pH studies. A good surgical result was not dependent upon an increase in the lower esophageal pressure following operation. The Boerema anterior gastropexy is simple and effective for controlling gastroesophageal reflux for cases uncomplicated by esophagitis, stricture, or previous operation. Complex cases with inflammatory or operative changes in the lower esophagus are more effectively treated by Nissen fundoplication.