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Gastroesophageal reflux in neonates with congenital abdominal wall defect
S Beaudoin1, G Kieffer, E Sapin
1Department of Pediatric Surgery, Hôpital Saint Vincent de Paul, Paris, France.
Insights
Gastroesophageal reflux (GER) is common in neonates with abdominal wall defects. This study investigated its causes, finding severity in omphalocele cases may necessitate earlier antireflux procedures during initial closure.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) is frequently observed in neonates with congenital abdominal wall defects.
- The exact cause of GER in these infants, whether solely due to abdominal hyperpressure or other factors, requires further investigation.
Purpose of the Study:
- To determine if abdominal hyperpressure alone causes GER in neonates with abdominal wall defects.
- To explore other potential contributing factors to GER in this population.
Main Methods:
- A retrospective study of 80 gastroschisis and 67 omphalocele cases treated between December 1982 and December 1992.
- Analysis of GER occurrence and severity in relation to defect type and surgical management.
Main Results:
- Approximately 50% of neonates with gastroschisis and omphalocele experienced GER.
- Neonates with wide omphaloceles requiring staged closure exhibited particularly severe GER.
- These severe cases often necessitated additional surgical antireflux procedures.
Conclusions:
- GER in neonates with abdominal wall defects is a significant concern, not merely a minor complication.
- Early antireflux procedures, potentially concurrent with initial defect closure, may be beneficial for neonates with wide omphaloceles.
- The favorable anatomy during initial closure presents an opportunity for earlier intervention.
Abstract:
Gastroesophageal reflux (GER), not yet described as a real complication, takes place very often in neonates with congenital abdominal wall defect. Our aim was to determine whether it is due to abdominal hyperpressure alone, or if another factor is involved in this occurrence. Thus we studied one group of 80 gastroschises and one of 67 omphaloceles, treated in our department between December 82 and December 92. Overall occurrence was found to be about 50% in both groups. The main feature is the particular severity of GER in neonates with wide omphalocele who required staged closure, leading to further surgical antireflux procedure. We suggest that this procedure could be performed earlier, at the time of closure, for these babies in whom moreover the anatomic approach is favorable.