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Gastroesophageal fundoplication for reflux in infants and children
Insights
Nissen fundoplication effectively treats symptomatic gastroesophageal reflux in infants and children. This surgical approach leads to significant weight gain and resolution of reflux symptoms, making it a highly satisfactory treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Symptomatic gastroesophageal reflux (GER) poses significant health risks in infants and young children.
- Effective management strategies for severe GER are crucial to prevent complications such as malnutrition and aspiration.
Purpose of the Study:
- To evaluate the efficacy and safety of Nissen fundoplication for treating symptomatic gastroesophageal reflux in pediatric patients.
- To assess the long-term outcomes and complications associated with surgical management of GER in this population.
Main Methods:
- Retrospective analysis of 15 infants and young children undergoing Nissen fundoplication for symptomatic GER.
- Diagnostic methods included barium esophagrams (standard and cine), esophagoscopy with biopsy, and esophageal manometry.
- Surgical indications included persistent reflux, failure to gain weight, malnutrition, recurrent aspiration, esophagitis, or stricture.
Main Results:
- Cine esophagrams were more sensitive than standard esophagrams in detecting reflux.
- Esophagoscopy with biopsy diagnosed esophagitis in 90% of patients evaluated.
- Fundoplication resulted in clinical relief of reflux, improved weight gain, and increased esophageal sphincter pressure in all patients.
- Concomitant gastrostomy prevented gas bloat syndrome, and postoperative dilatation effectively managed strictures.
Conclusions:
- Nissen fundoplication is a highly satisfactory and safe surgical treatment for symptomatic gastroesophageal reflux in infants and children.
- Aggressive surgical management is warranted given the severe potential consequences of untreated GER.
- Fundoplication offers significant long-term benefits, including symptom resolution and improved nutritional status.
Abstract:
Fifteen infants and young children with symptomatic gastroesophageal reflux underwent fundoplication during a 6 1/2-yr period. Standard barium esophagrams clearly demonstrated reflux in only 10 of the 15 patients; however, cine esophagrams indicated reflux in the remaining patients. Esophagoscopy with mucosal biopsy demonstrated esophagitis in 9 of the 10 patients in whom it was performed, and it is a very helpful diagnostic procedure. Esophageal manometry showed low sphincter pressures in each of 7 patients. Fundoplication was performed when there was (1) persistent reflux after a 3-wk hospital course of vigorous medical management, (2) failure to gain weight, (3) malnutrition, (4) recurrent aspiration, (5) esophagitis, or (6) stricture. Concomitant gastrostomy prevented the gas bloat syndrome in all patients. All strictures were successfully relieved by postoperative dilatation (average four per patient). Esophageal replacement is rarely indicated for strictures due to reflux in children. No deaths or major complications occurred following operation. Each of the patients has been relieved of clinical reflux, and each has gained weight more rapidly than preoperatively. Follow-up esophagrams on each of the patients show absence of reflux, and manometry shows the low esophageal sphincter pressure to be increased an average of 10 mm Hg above preoperative values. Since the results of Nissen fundoplication to correct reflux in infants and young children are highly satisfactory, and since the consequences of persistent reflux may be severe, a fairly aggressive approach should be taken in the management of symptomatic reflux.