This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fonkalsrud, E. W.
Right arrow Articles by Weber, T. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fonkalsrud, E. W.
Right arrow Articles by Weber, T. R.
Related Collections
Right arrow Gastrointestinal Tract

PEDIATRICS Vol. 101 No. 3 March 1998, pp. 419-422

Surgical Treatment of Gastroesophageal Reflux in Children: A Combined Hospital Study of 7467 Patients

Received Jul 21, 1997; accepted Sep 9, 1997.

Eric W. Fonkalsrud*, Keith W. AshcraftDagger , Arnold G. Coran§, Dick G. Ellisparallel , Jay L. Grosfeld, William P. Tunell#, and Thomas R. Weber**

From the Departments of Surgery, * UCLA School of Medicine, Los Angeles, California; Dagger  Children's Mercy Hospital, Kansas City, Missouri; § C. S. Mott Children's Hospital, Ann Arbor, Michigan; parallel  Cook Forth Worth, Children's Hospital, Fort Worth, Texas;  J. W. Riley Children's Hospital, Indianapolis, Indiana; # Children's Hospital, Oklahoma City, Oklahoma; and ** Cardinal Glennon Children's Hospital, St Louis, Missouri.

Objective.  To review retrospectively the combined clinical experience with the surgical treatment of persistently symptomatic gastroesophageal reflux (SGER) in childhood from seven large children's surgery centers in the United States.

Design.  During the past 20 years, 7467 children <18 years of age underwent antireflux operations for SGER at the seven participating hospitals. Fifty-six percent were neurologically normal (NN) and 44% were neurologically impaired (NI). The most frequent diagnostic studies were upper gastrointestinal series (68%), esophageal pH monitoring (54%), gastric emptying study (32%), and esophagoscopy (25%). The age at operation was under 12 months in 40% and 1 to 10 years in 48%. The type of fundoplication was Nissen (64%), Thal (34%), and Toupet (1.5%). A gastric emptying procedure was performed on 11.5% of NN patients and 40% of NI patients. Laparoscopic fundoplication was performed on 2.6% of patients.

Results.  Good to excellent results were achieved in 95% of NN and 84.6% of NI patients. Major complications occurred in 4.2% of NN and 12.8% of NI patients. The most frequent complications were recurrent reflux attributable to wrap disruption (7.1%), respiratory (4.4%), gas bloat (3.6%), and intestinal obstruction (2.6%). Postoperative death occurred in 0.07% of NN and 0.8% of NI patients. Reoperation was performed in 3.6% of NN and 11.8% of NI patients. The results and complications were similar among the participating hospitals and did not seem related to the type of fundoplication used.

Conclusion.  The excellent results (94% cure) and low morbidity with gastroesophageal fundoplication with or without a gastric emptying procedure from a large combined hospital study indicate that operation should be used early for SGER in NN children and to facilitate enteral feedings and care in NI children.

Key words: gastroesophageal reflux, gastroesophageal fundoplication, delayed gastric emptying.




This article has been cited by other articles:


Home page
 Arch SurgHome page
S. L. Lee, R. M. Sydorak, V. Y. Chiu, J.-W. Hsu, H. Applebaum, and P. I. Haigh
Long-term Antireflux Medication Use Following Pediatric Nissen Fundoplication
Arch Surg, September 1, 2008; 143(9): 873 - 876.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. S. Lasser, J. G. Liao, and R. S. Burd
National Trends in the Use of Antireflux Procedures for Children
Pediatrics, November 1, 2006; 118(5): 1828 - 1835.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
S. Chawla, D. Seth, P. Mahajan, and D. Kamat
Gastroesophageal Reflux Disorder: A Review for Primary Care Providers
Clinical Pediatrics, January 1, 2006; 45(1): 7 - 13.
[PDF]

Home page
 Arch. Dis. Child.Home page
E Hassall
Outcomes of fundoplication: causes for concern, newer options
Arch. Dis. Child., October 1, 2005; 90(10): 1047 - 1052.
[Abstract] [Full Text] [PDF]

Home page
 AAP Grand RoundsHome page
N. S. LeLeiko
Surgical Fundoplication: No Panacea for GERD
AAP Grand Rounds, March 1, 2005; 13(3): 34 - 34.
[Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
J. W. Harrington, D. A. Brand, and K. S. Edwards
Seizure Disorder as a Risk Factor for Gastroesophageal Reflux in Children with Neurodevelopmental Disabilities
Clinical Pediatrics, July 1, 2004; 43(6): 557 - 562.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
D. A. Gremse
Gastroesophageal Reflux: Life-Threatening Disease or Laundry Problem?
Clinical Pediatrics, July 1, 2002; 41(6): 369 - 372.
[PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
M MARKIEWICZ and Y VANDEN PLAS
Should cisapride have been "blacklisted"?
Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2000; 82(1): 3F - 4.
[Full Text]

Home page
 Arch SurgHome page
T. R. Weber
Toupet Fundoplication for Gastroesophageal Reflux in Childhood
Arch Surg, July 1, 1999; 134(7): 717 - 720.
[Abstract] [Full Text] [PDF]