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Gastroesophageal reflux in neurologically impaired children: partial or total fundoplication?
E Ceriati1, N Guarino, A Zaccara
1Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
For neurologically impaired children with gastroesophageal reflux disease, both Nissen and Thal fundoplication showed similar success rates and complication risks. The Thal procedure, however, offered shorter operative times and hospital stays.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Background:
- Gastroesophageal reflux disease (GERD) management in neurologically impaired children lacks standardized surgical guidelines.
- Surgical interventions for GERD in this population are increasing, yet consensus on the optimal technique is absent.
- Comparative studies on different fundoplication procedures for pediatric GERD are limited.
Purpose of the Study:
- To retrospectively compare the short- and long-term outcomes of Nissen fundoplication versus Thal fundoplication in neurologically impaired children with GERD.
- To evaluate the efficacy and safety of two distinct surgical approaches for managing GERD in a vulnerable pediatric population.
Main Methods:
- Retrospective analysis of 47 neurologically impaired children with documented GERD who underwent either Nissen (n=27) or Thal (n=20) fundoplication.
- Comparison of outcomes including recovery rates, minor/major complications, operative time, and hospital stay.
- Statistical analysis using relative odds for complications and Student's t-test for operative time and hospital stay.
Main Results:
- No statistically significant difference was observed in complication risk or success rates between Nissen and Thal fundoplication groups.
- Operative duration was significantly shorter for the Thal fundoplication group (Group B) compared to the Nissen group (Group A).
- Hospital stay was also significantly reduced in patients who underwent Thal fundoplication.
Conclusions:
- Both Nissen and Thal fundoplication are effective in managing GERD in neurologically impaired children, with comparable success and complication profiles.
- The Thal fundoplication procedure demonstrates advantages in reduced operative time and length of hospital stay.
- Thal fundoplication can be considered a preferred first-line surgical option for this patient cohort.
Background:
It is difficult to give guidelines when approaching gastroesophageal disease in neurologically impaired children. Indication for surgery has been increasing over recent years, but there is no consensus on the surgical technique of choice. Nothing has been written specifically comparing the results of different procedures in these patients, so far.
Study Design:
We retrospectively compare the short- and long-term results of two different types of fundoplication in a series of children operated on for documented gastroesophageal reflux disease at our institution.
Results:
One group (group A) of 27 patients, operated on between 1977 and 1993, underwent Nissen fundoplication, the other (group B), formed of 20 patients all of whom were operated on between 1993 and 1995, underwent Thai fundoplication. We compared the results in terms of positive outcome (recovery) and negative outcome (minor and major complication), computing the relative odds of group A versus group B in terms of risk of complication, and we compared the mean operative time and the length of hospital stay by means of a student's t-test analysis.
Conclusions:
Our results show that there is no statistical difference between the two procedures in terms of relative risk of complication and success rate. The duration of surgery and hospital stay were significantly shorter in group B. The Thal procedure can, therefore, be proposed as first choice in the management of these patients.