A multicenter study of the incidence and factors associated with redo Nissen fundoplication in children

Baerg, Joanne; Thorpe, Donna; Bultron, Gilberto; Vannix, Rosemary; Knott, E. Marty; Gasior, Alessandra C.; Sharp, Susan W.; Tagge, Edward P.; Peter, Shawn D. St.

doi:10.1016/j.jpedsurg.2013.03.028

Cited by 40 publications

(31 citation statements)

References 24 publications

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“…The incidence of retching in our population of ONF is 50% and comparable to recent published data 21. The incidence of retching after antireflux surgery in children reported in the literature is variable between 20% and 56%, higher in the neurologically impaired patients, and it has been documented in up to 63% of children requiring redo-fundoplication 20 21. In our series 66.6% of children with postoperative retching were neurologically impaired with equal distribution in the two groups and the use of standardised surgical procedures makes any bias related to patient's selection unlikely.…”

Section: Discussionsupporting

confidence: 91%

“…It is likely that the mechanism leading to postoperative dysphagia in adults and retching in children is different. The incidence of retching in our population of ONF is 50% and comparable to recent published data 21. The incidence of retching after antireflux surgery in children reported in the literature is variable between 20% and 56%, higher in the neurologically impaired patients, and it has been documented in up to 63% of children requiring redo-fundoplication 20 21.…”

Section: Discussionsupporting

confidence: 87%

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Four year follow-up of a randomised controlled trial comparing open and laparoscopic Nissen fundoplication in children

Pacilli

Eaton

McHoney

et al. 2014

Archives of Disease in Childhood

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ObjectiveTo evaluate the 4-year results following a randomised controlled trial (RCT) comparing open (ONF) and laparoscopic (LNF) Nissen fundoplication in children.BackgroundIt is assumed that long-term results of ONF and LNF are comparable. No randomised studies have been performed in children.MethodsA follow-up study was performed in children randomised to ONF or LNF (clinicaltrials.gov identifier NCT00259961). Recurrent gastro-oesophageal reflux (GER) was documented by upper gastrointestinal contrast study and/or 24-h pH study. Nutritional status, retching and other symptoms were investigated. A questionnaire was used to assess the quality of life before and after surgery.ResultsThirty-nine children were randomised to ONF (n=20) or LNF (n=19). There were 15 ONF and 16 LNF neurologically impaired children. One patient (ONF group) was lost to follow-up. Follow-up was 4.1 years (3.1–5.3) for ONF group and 4.1 years (2.6–5.1) for LNF group (p=0.9). Seven neurologically impaired children had died by the time of follow-up (3 ONF, 4 LNF). Incidence of recurrent GER was 12.5% in the ONF and 20% in the LNF (p=ns). One patient in each group underwent redo-Nissen fundoplication. Nutritional status improved in both groups, as indicated by a significant increase in weight Z-score (p<0.01). Gas bloat and dumping syndrome were present in both groups (p=ns). Incidence of retching was lower in the laparoscopic group (p=0.01). Quality of life improved in both groups (p=ns).ConclusionsOpen and laparoscopic Nissen provide similar control of reflux and quality of life at follow-up. LNF is associated with reduced incidence of retching persisting at 4-year follow-up.Trial registration numberNCT00259961.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Four year follow-up of a randomised controlled trial comparing open and laparoscopic Nissen fundoplication in children

Pacilli

Eaton

McHoney

et al. 2014

Archives of Disease in Childhood

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“…It has been suggested that recurrence of GERD and even the necessity for redo-fundoplication are more frequently seen in young patients. These suggestions were based on two retrospective studies both using regression analysis to identify risk factors [39, 40]. Bearg et al [39] showed that redo-fundoplication is significantly more frequent if patients are younger or have retching.…”

Section: Discussionmentioning

confidence: 99%

“…These suggestions were based on two retrospective studies both using regression analysis to identify risk factors [39, 40]. Bearg et al [39] showed that redo-fundoplication is significantly more frequent if patients are younger or have retching. Ngerncham et al [40] reported that age less than 6 years was independently associated with increased risk of recurrence of GERD.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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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“…In children, growing evidence suggests that extensive esophageal dissection is not necessary and may in fact contribute to fundoplication failure by promoting transmigration of the wrap through the esophageal hiatus. Dissection of the esophagus at the hiatus was identifi ed as a risk factor for re-do fundoplication in children, along with a younger age at fi rst fundoplication and retching [ 24 ]. A single surgeon retrospective historical comparison demonstrated a decrease in the rate of wrap transmigration from 12 to 5 % by altering the surgical technique to perform minimal esophageal dissection, leaving the phrenoesophageal membrane intact and using two to four sutures to approximate the esophagus and the crura [ 25 ].…”

Section: Surgical Therapy For Pediatric Gerdmentioning

confidence: 99%

Diagnosis and Management of Gastroesophageal Reflux Disease in Pediatric Patients

Jackson

2015

Fundoplication Surgery

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A multicenter study of the incidence and factors associated with redo Nissen fundoplication in children

Cited by 40 publications

References 24 publications

Four year follow-up of a randomised controlled trial comparing open and laparoscopic Nissen fundoplication in children

Four year follow-up of a randomised controlled trial comparing open and laparoscopic Nissen fundoplication in children

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

Diagnosis and Management of Gastroesophageal Reflux Disease in Pediatric Patients

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