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Modified Toupet wrap for gastroesophageal reflux in childhood
Insights
This study followed children who had a partial Toupet wrap for gastroesophageal reflux (GER). The wrap is a safe and effective surgical option for GER in children, preserving their ability to belch and vomit.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Gastroesophageal reflux (GER) is a common condition in infants and children.
- Surgical intervention, such as the Toupet wrap, is considered for refractory GER.
- Evaluating long-term outcomes of different surgical techniques is crucial for pediatric care.
Purpose of the Study:
- To assess the efficacy and safety of partial (posterior) Toupet wrap and modified Toupet fundoplication in pediatric patients.
- To evaluate the long-term functional outcomes and complication rates following these anti-reflux procedures.
Main Methods:
- Follow-up study of 22 children who underwent partial (posterior) Toupet wrap or modified Toupet fundoplication.
- Preoperative GER assessments and postoperative pH-metry and upper gastrointestinal series with reflux testing.
- Assessment of surgical success, complications, and functional outcomes including the ability to belch and vomit.
Main Results:
- Successful GER control in 95.5% of children (21 out of 22).
- One reoperation was required for recurrent sliding hiatal hernia and GER.
- 18.2% experienced functional complications; no gas bloat syndrome occurred. All patients could belch and vomit.
Conclusions:
- Partial (posterior) Toupet wrap and modified Toupet fundoplication are safe and effective for pediatric GER surgery.
- These procedures successfully manage GER while preserving the ability to belch and vomit.
- The modified Toupet fundoplication with Vicryl-mesh reinforcement demonstrates favorable outcomes in this pediatric cohort.
Unlabelled:
It was the aim of our study to follow up our clientele of infants and children who had undergone a partial (posterior) Toupet wrap or modified Toupet wrap.
Methods:
All 22 children who had undergone a posterior partial wrap within a 4-year period were followed up for 4.0 years (0.6-5.7 years). 36.4% of children had associated anomalies such as operated esophageal atresia, operated congenital diaphragmatic hernia, Gregg's syndrome or arthrogryposis multiplex congenita. 14% of children suffered from some form of neurological impairment. Prior to operation the 4 main examinations for detection and documentation of gastroesophageal reflux (GER) disease were carried out where possible. Five children underwent Toupet fundoplication and in 17 children a modified Toupet fundoplication with reinforcement of the wrap fixation using a Vicryl-mesh was applied. A pH-metric study and upper gastrointestinal series with reflux testing were done in all 22 children at least 6 months postoperatively. Successful control of GER was documented in 21 of 22 children (95.5%). In the remaining child a reoperation was necessary to correct recurrence of a sliding hiatal hernia and GER. In three children (13.6%) postoperative complications occurred within the first 2 weeks following fundoplication and were managed medically. Following the postoperative 24-hour pH-metric study and the upper gastrointestinal series with reflux testing, one child with normal results at these investigations was lost to follow-up. The remaining 21 children were followed up for another 10 months to 5 years. Four children (18.2%) were found to suffer from functional complications (mild dumping syndrome, retrosternal pain, vomiting during episodes of asthma, dysphagia). No gas bloat syndrome occurred within the follow-up interval and all children were able to belch and vomit. There was no mortality in our limited series. Our series indicates that the partial (posterior) Toupet wrap and the modified Toupet fundoplication are safe and effective procedures for surgical correction of GER in children which preserve the ability of infants and children to belch and vomit.