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The effect of gastroesophageal reflux on laryngotracheal reconstruction
G H Zalzal1, S S Choi, K M Patel
1Department of Otolaryngology - Head and Neck Surgery, George Washington University, Washington, DC, USA.
Insights
Routine preoperative evaluation for gastroesophageal reflux disease (GERD) is not necessary for children undergoing laryngotracheal reconstruction (LTR). The study found that GERD and its treatment do not significantly impact LTR outcomes.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Gastroenterology
Background:
- Laryngotracheal reconstruction (LTR) is a complex procedure for pediatric airway stenosis.
- Gastroesophageal reflux disease (GERD) is a common comorbidity in children with airway issues.
- The necessity of preoperative GERD evaluation for LTR outcomes remains debated.
Purpose of the Study:
- To determine if all pediatric patients require preoperative evaluation for GERD before LTR.
- To assess the influence of GERD and its treatment on the success of LTR.
Main Methods:
- Prospective, single-blind observational study at a tertiary care children's hospital.
- Included 74 pediatric patients undergoing LTR between 1986 and 1994.
- Outcomes measured by successful decannulation and granulation tissue removal via endoscopy.
Main Results:
- No significant difference in LTR outcomes (decannulation, granulation tissue) was observed across groups with varying GERD evaluation and treatment statuses.
- Neither the presence of GERD nor its treatment were found to be major factors influencing LTR success.
- Severity and extent of stenosis were similar across patient groups.
Conclusions:
- Preoperative GERD evaluation is not universally required for pediatric LTR.
- GERD status and its management do not appear to significantly affect LTR outcomes.
Objectives:
To determine the need for preoperative evaluation for gastroesophageal reflux disease (GERD) in all children undergoing laryngotracheal reconstruction (LTR) and to assess the effect of GERD on the outcome of LTR.
Design:
Prospective, single-blind observational study.
Setting:
Tertiary care children's hospital.
Patients:
Seventy-four pediatric patients with laryngotracheal stenosis who underwent LTR at the Children's National Medical Center, Washington, DC, from October 1, 1986, through August 31, 1994.
Intervention:
Evaluation for and treatment of GERD, LTR, endoscopy, and removal of granulation tissue.
Main Outcome Measures:
Successful decannulation and number of endoscopies required to remove laryngeal and tracheal granulation tissue.
Results:
Seventy-four patients underwent 82 LTRs. The senior surgeon was blinded to the status of GERD evaluation and treatment. Four groups were identified: 37 patients (40 LTRs) with no preoperative evaluation for GERD; 10 patients (11 LTRs) with normal findings on preoperative evaluation for GERD; seven patients (nine LTRs) with abnormal findings on preoperative evaluation for GERD but who failed to receive appropriate treatment; and 20 patients (22 LTRs) with abnormal findings on preoperative evaluation for GERD who received appropriate therapy. Severity and extent of stenosis as determined by multicentricity of stenosis, type of repair, and duration of stent were similar in the four groups. The effect of GERD and its treatment on the outcome of LTR was measured by the number of endoscopies necessary for removal of granulation tissue following reconstruction and successful decannulation. Statistical analyses indicate that (1) all children do not require preoperative evaluation for GERD; (2) neither the presence of GERD nor its treatment are major factors in determining the outcome of LTR.
Conclusion:
Preoperative evaluation for GERD and its treatment do not favorably affect the outcome of LTR.