Laparoscopic Thal Fundoplication in Children

Mauritz, Femke A.; Herwaarden-Lindeboom, Maud Y. A. van; Zwaveling, Sander; Houwen, Roderick H. J.; Siersema, Peter D.; Zee, David C. van der

doi:10.1097/sla.0b013e318294102e

Cited by 24 publications

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“…Remarkably, however, recurrence or persisting pathological acid exposure did not significantly influence HRQoL. It has been described before that reflux symptoms do not correlate to objective measurements of GERD, which may underscore the difficulty in symptom assessment [3, 4, 42]. …”

Section: Discussionmentioning

confidence: 90%

“…Thereafter, the fundoplication was constructed. The Thal fundoplication was performed by plicating the fundus of the stomach over 270° against the distal anterior intra-abdominal part of the esophagus and the diaphragmatic crus [3, 18]. A floppy Nissen was constructed with one of the sutures of the 360° posterior wrap incorporated in the esophageal wall [19].…”

Section: Methodsmentioning

confidence: 99%

“…LARS primarily aims to decrease (acid) reflux events and to reduce reflux symptoms. However, as shown in earlier studies the effect on reflux symptoms does not always correlate to more objective assessments of success of therapy [3, 4]. Furthermore, comorbidities (e.g., impaired neurodevelopment) and complications, such as dysphagia and gas-bloat syndrome [5], may also affect success of therapy.…”

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confidence: 99%

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Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

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IntroductionImproving health-related quality of life (HRQoL) is increasingly recognized as an essential part of patient care outcome. Little is known about the effect of laparoscopic antireflux surgery (LARS) on the HRQoL in the pediatric patients. The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease (GERD) and to identify predictors that influence HRQoL outcome after LARS.MethodsBetween 2011 and 2013, 25 patients with therapy-resistant GERD [median age 6 (2–18) years] were included prospectively. Caregivers and children with normal neurodevelopment (>4 years) were asked to fill out the validated PedsQL 4.0 Generic Core Scales before and 3–4 months after LARS.ResultsThe PedsQL was completed by all caregivers (n = 25) and 12 children. HRQoL total score improved significantly after LARS, both from a parental (p = 0.009) and child’s perspective (p = 0.018). The psychosocial health summary and physical health summary scores also improved significantly after LARS. HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment (p < 0.001). However, neurodevelopment did not influence the effect of LARS on HRQoL. The only significant predictor for improvement in HRQoL after LARS was age at the time of operation (p = 0.001).ConclusionsHRQoL significantly improves after LARS. Although children with impaired neurodevelopment had lower overall HRQoL, neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS. Older children have a more favorable HRQoL outcome after LARS compared to younger children. This may suggest caution when considering LARS in younger GERD patients.

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Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

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“…Thereafter, the fundoplication was constructed. The Thal fundoplication was performed by plicating the fundus of the stomach over 270° against the distal anterior intra-abdominal part of the esophagus and the diaphragmatic crus [17]. A floppy Nissen was constructed with one of the sutures of the 360° posterior wrap incorporated in the esophageal wall [16].…”

Section: Methodsmentioning

confidence: 99%

Esophageal mucosal integrity improves after laparoscopic antireflux surgery in children with gastroesophageal reflux disease

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BackgroundEsophageal intraluminal baseline impedance reflects the conductivity of the esophageal mucosa and may be an instrument for in vivo evaluation of mucosal integrity in children with gastroesophageal reflux disease (GERD). Laparoscopic antireflux surgery (LARS) is a well-established treatment option for children with proton pump inhibitory (PPI) therapy resistant GERD. The effect of LARS in children on baseline impedance has not been studied in detail. The aim of this study was to evaluate the effect of LARS on baseline impedance in children with GERD.MethodsThis is a prospective, multicenter, nationwide cohort study (Dutch national trial registry: NTR2934) including 25 patients [12 males, median age 6 (range 2–18) years] with PPI-resistant GERD scheduled to undergo LARS. Twenty-four hour multichannel intraluminal impedance pH monitoring (MII-pH monitoring) was performed before and 3 months after LARS. Baseline impedance was evaluated during consecutive 2-h intervals in the 24-h tracings.ResultsLARS reduced acid exposure time from 8.5 % (6.0–16.2 %) to 0.8 % (0.2–2.8 %), p < 0.001. Distal baseline impedance increased after LARS from 2445 Ω (1147–3277 Ω) to 3792 Ω (3087–4700 Ω), p < 0.001. Preoperative baseline impedance strongly correlated with acid exposure time (r −0.76, p < 0.001); however, no association between symptomatic outcome and baseline impedance was identified.ConclusionsLARS significantly increased baseline impedance likely reflecting recovery of mucosal integrity. As the change in baseline impedance was not associated with the clinical outcome of LARS, other factors besides mucosal integrity may contribute to symptom perception in children with GERD.

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“…Such questionnaires, however, have not been used in the majority of pediatric LARS studies [ 15 ]. In addition to evaluation of reflux symptoms, more objective assessments of (acid) reflux, such as multichannel intraluminal impedance pH (MII-pH) monitoring, should be performed [ 9 , 10 , 16 ].…”

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Effects and efficacy of laparoscopic fundoplication in children with GERD: a prospective, multicenter study

et al. 2016

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IntroductionLaparoscopic antireflux surgery (LARS) in children primarily aims to decrease reflux events and reduce reflux symptoms in children with therapy-resistant gastroesophageal reflux disease (GERD). The aim was to objectively assess the effect and efficacy of LARS in pediatric GERD patients and to identify parameters associated with failure of LARS.MethodsTwenty-five children with GERD [12 males, median age 6 (2–18) years] were included prospectively. Reflux-specific questionnaires, stationary manometry, 24-h multichannel intraluminal impedance pH monitoring (MII-pH monitoring) and a 13C-labeled Na-octanoate breath test were used for clinical assessment before and 3 months after LARS.ResultsAfter LARS, three of 25 patients had persisting/recurrent reflux symptoms (one also had persistent pathological acid exposure on MII-pH monitoring). New-onset dysphagia was present in three patients after LARS. Total acid exposure time (AET) (8.5–0.8 %; p < 0.0001) and total number of reflux episodes (p < 0.001) significantly decreased and lower esophageal sphincter (LES) resting pressure significantly increased (10–24 mmHg, p < 0.0001) after LARS. LES relaxation, peristaltic contractions and gastric emptying time did not change. The total number of reflux episodes on MII-pH monitoring before LARS was a significant predictor for the effect of the procedure on reflux reduction (p < 0.0001).ConclusionsIn children with therapy-resistant GERD, LARS significantly reduces reflux symptoms, total acid exposure time (AET) and number of acidic as well as weakly acidic reflux episodes. LES resting pressure increases after LARS, but esophageal function and gastric emptying are not affected. LARS showed better reflux reduction in children with a higher number of reflux episodes on preoperative MII-pH monitoring.

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Laparoscopic Thal Fundoplication in Children

Abstract: As gastroesophageal reflux persists or recurs in 43% of children 10 to 15 years after laparoscopic Thal fundoplication, it is crucial to implement routine long-term follow-up after ARS in pediatric patients with gastroesophageal reflux disease.

Cited by 24 publications

References 30 publications

Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

Laparoscopic antireflux surgery increases health-related quality of life in children with GERD

Esophageal mucosal integrity improves after laparoscopic antireflux surgery in children with gastroesophageal reflux disease

Effects and efficacy of laparoscopic fundoplication in children with GERD: a prospective, multicenter study

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