Recurrent gastroesophageal reflux in neurologically impaired patients after fundoplication
- 20 December 2006
- journal article
- Published by Wiley in Acta Paediatrica
- Vol. 96 (1), 87-93
- https://doi.org/10.1111/j.1651-2227.2006.00005.x
Abstract
To evaluate the outcome and analyse the main causes of complications and failures of antireflux surgery for gastroesophageal reflux disease (GERD) in neurologically impaired patients (NIP). From 1985 to 1999 44 NIP (mean age 12 years) underwent surgery for GERD. Type of surgery, complications and recurrent reflux were analysed. Twenty-seven patients (61%) showed preoperatively severe failure to thrive. All patients showed pathologic results in 24-h pH monitoring. Surgical treatment consisted of ventral (n = 25, Thal) or dorsal (n = 4, Toupet) semifundoplication or a Nissen fundoplication (n = 15). Postoperatively, all patients showed an impressive growth, regress of symptoms and improvement of results of diagnostic investigations. Late complications and recurrence of reflux were significantly related to preoperative extreme dystrophy (p < 0.0025). In six patients (15%) severity of symptoms related to recurrent reflux required a reoperation 17.8 month postoperatively (range 8-35 month). Recurrent reflux was found in 40% after ventral semifundoplication and in 46% after Nissen fundoplication (8 and 47 months postoperatively, respectively). Symptoms improved impressively after fundoplication in mentally retarded children. The incidence of recurrent reflux is not related to the type of surgery, however, it occurs significantly earlier with ventral semifundoplication when compared with Nissen fundoplication. Both late complications as well as recurrent reflux are related significantly to preoperative dystrophy.Keywords
This publication has 27 references indexed in Scilit:
- The continuum of GERD complications.Cleveland Clinic Journal of Medicine, 2003
- Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired childrenSurgical Endoscopy, 2003
- Motion – Laparoscopic Nissen Fundoplication Is More Cost Effective Than Oral PPI Administration: Arguments for the MotionCanadian Journal of Gastroenterology, 2002
- Percutaneous gastrojejunostomy versus Nissen fundoplication for enteral feeding of the neurologically impaired child with gastroesophageal refluxThe Journal of Pediatrics, 1993
- Efficacy and safety of omeprazole for severe gastroesophageal reflux in childrenThe Journal of Pediatrics, 1993
- Sequelae of antireflux surgery in profoundly disabled childrenJournal of Pediatric Surgery, 1992
- Complications of gastroesophageal antireflux surgery in neurologically impaired versus neurologically normal childrenJournal of Pediatric Surgery, 1990
- Complications and reoperation after Nissen fundoplication in childhoodThe American Journal of Surgery, 1987
- Address of honored guest: The physiologic approach to the management of gastric esophageal refluxJournal of Pediatric Surgery, 1986
- Results and complications of surgery for gastro-oesophageal reflux.Archives of Disease in Childhood, 1985