Effectiveness of fundoplication in early infancy

Kubiak, Rainer; Spitz, Lewis; Kiely, Edward M.; Drake, D. P.; Pierro, Agostino

doi:10.1016/s0022-3468(99)90194-x

Cited by 66 publications

(45 citation statements)

References 21 publications

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“…The recurrence rate following redo Nissen fundoplication in our series is higher for NI children (48%). Different studies have documented that the results of the first fundoplication are negatively influenced by the presence of neurological impairment and associated anomalies, both in children [6,8,[20][21][22][23][24], and infants [25] and several authors [24][25][26][27][28][29][30] have reported that the fundoplication is associated with a higher recurrence rate in patient with repaired oesophageal atresia (up to 24%). Associated anomalies were present in about 50% of the patients that required redo fundoplication.…”

Section: Discussionmentioning

confidence: 99%

Factors predicting failure of redo Nissen fundoplication in children

et al. 2007

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Recurrence of gastro-oesophageal reflux (GOR) following redo Nissen fundoplication represents a significant clinical problem. The aim of this study was to identify factors predicting failure of redo Nissen fundoplication. The notes of children who underwent redo Nissen fundoplication for recurrent GOR in a single institution between June 1994 and May 2005 were reviewed. Data are reported as median (range), or as numbers of cases. Multiple logistic regression analysis, using type of first fundoplication, neurological status, presence of gastrostomy, age-weight, retching-gas bloat after first fundoplication, associated anomalies, oesophageal atresia and length of follow-up as factors, was used to generate a model to identify factors predicting recurrent vomiting (failure) after redo. Eighty-one children underwent redo Nissen fundoplication 15.9 months (0.2-176) after the initial Nissen fundoplication. In 29, the first Nissen was laparoscopic. Age at redo Nissen fundoplication was 3.3 years (0.3-15.9) and weight 12.8 kg (5-60). Thirty-four children (42%) presented with recurrent vomiting (failure). Overall, the model successfully predicted vomiting (failure) after redo fundoplication (P = 0.009). Open surgery at first fundoplication (P = 0.011) and neurological impairment (P = 0.046) were both significant predictors of redo failure in the model, whereas presence of gastrostomy (P = 0.035) and older-heavier age-weight (P = 0.028) were associated with significantly better results. Retching-gas bloat, associated anomalies and oesophageal atresia were not significant predictors of failure. Redo Nissen fundoplication has a high failure rate. Risk factors are open fundoplication at first operation and neurological impairment. Redo fundoplication after primary laparoscopic Nissen has a lower risk of failure.

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Section: Discussionmentioning

confidence: 99%

Factors predicting failure of redo Nissen fundoplication in children

et al. 2007

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“…21 Our results have led us to speculate, although we do not have direct data as proof, that gastroesophageal reflux contributes to an increased exacerbation frequency in children with CP by causing aspiration into the lower airways. Given the efficacy of Nissen fundoplication in treating gastroesophageal reflux-related digestive and respiratory disturbances in chronically ill children, [31][32][33] it probably seems counterintuitive that, in our experience, subjects undergoing this type of anti-reflux surgery show no significant improvement: their exacerbation risk is similar to that of subjects who have not undergone the procedure. Indeed, the results of our study agree with previous data demonstrating that Nissen fundoplication does not lead to improvement in respiratory disturbances in ϳ50% of neurologically impaired children.…”

Section: Discussionmentioning

confidence: 67%

“…Indeed, the results of our study agree with previous data demonstrating that Nissen fundoplication does not lead to improvement in respiratory disturbances in ϳ50% of neurologically impaired children. 31 Further studies are needed to elucidate the association between gastroesophageal reflux and respiratory exacerbation and the utility of Nissen fundoplication in this patient population. Among studies aiming to identify the most common factors related to pulmonary exacerbation risk in subjects with CP, ours is probably the first that has highlighted an association between exacerbation risk and P aCO 2 : subjects presenting with higher P aCO 2 had a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Pulmonary Function Markers of Respiratory Exacerbation Risk in Subjects With Quadriplegic Cerebral Palsy

Vianello¹,

Carraro

Pipitone

et al. 2015

Respir Care

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BACKGROUND: Although respiratory exacerbations are common in patients with quadriplegic cerebral palsy (CP), little is known about the factors that are related to increased exacerbation risk. This study aimed to identify the clinical and pulmonary function variables signaling risk of exacerbation in this type of patient. METHODS: Thirty-one children and young adults with quadriplegic CP underwent a comprehensive history, physical examination, and pulmonary function test, including arterial blood gas analysis, airway resistance using the interrupter technique, and home overnight S pO 2 monitoring. Subjects were divided into 2 groups depending on the number of respiratory exacerbations reported during the year before study entry: frequent exacerbators (ie, > 2 exacerbations) and infrequent exacerbators (ie, < 2 exacerbations). RESULTS: The frequent exacerbators were more likely to require hospitalization due to respiratory disorders compared with the infrequent exacerbators (13/14 vs 9/17, P ‫؍‬ .02). Respiratory exacerbation was found to be associated with diagnosis of gastroesophageal reflux (adjusted odds ratio of 23.95 for subjects with confirmed diagnosis, P ‫؍‬ .02) and higher P aCO 2 levels (adjusted odds ratio of 12.60 for every 5-mm Hg increase in P aCO 2 , P ‫؍‬ .05). Subjects with P aCO 2 > 35 mm Hg showed an exacerbation odds ratio of 15.2 (95% CI 1.5-152.5, P ‫؍‬ .01). CONCLUSIONS: Gastroesophageal reflux and increased P aCO 2 can be considered simple, clinically useful markers of increased exacerbation risk in young subjects with quadriplegic CP.

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“…Os ín-dices de óbitos pós-operatórios até 30 dias variam entre zero e 24%, mais freqüentemente em torno de 5%. Associação de cardiopatias congênitas graves, desnutrição grave e doença respiratória severa (broncodisplasia pulmonar, bronquiectasias, DPOC grave) são fatores para a piora do prognóstico 22 . Tardiamente o tempo de sobrevida não parece ser significativamente melhorado pela cirurgia, apesar desta possibilitar melhora significativa da qualidade de vida do paciente e dos familiares e da causa mortis associar-se a problemas decorrentes da doença de base nas crianças operadas, ao passo que em geral a morte é causada por doença respiratória secundária a mecanismos de refluxo e aspiração no EP não operado 23 .…”

Section: Riscos E Resultadosunclassified

Refluxo gastroesofágico no paciente encefalopata

Jesus

2002

Rev. Col. Bras. Cir.

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O estudo da doença do refluxo gastroesofágico (DRGE) é cercado de controvérsia na criança, principalmente devido às dificuldades para diferenciar doença e imaturidade. O refluxo de conteúdo gástrico ao esôfago em menores de quatro meses de idade é fisiológico, causado por imaturidade e não por disfunção patológica do mecanismo de contenção da junção esofagogástrica (JEG) 1 , o que não implica, no entanto, que não possa haver casos de DRGE nesta faixa etária. O somatório destes conceitos levou à noção prática de que sempre que possível o RGE deve ser tratado conservadoramente no primeiro semestre de vida, exceto em circunstâncias onde a sintomatologia se torna incontrolável clinicamente e/ou de alto risco para o paciente (pneumonias de repetição em vigência de tratamento adequado, crises apnéicas/ bradicardia, retardo de crescimento e desenvolvimento).Na criança encefalopata (EP) esta discussão adquire outras nuances por incorporar aspectos ligados à necessidade de vias especiais de alimentação enteral (geralmente gastrostomia -GT) pela presença de distúrbios da deglutição e às alterações definitivas da função dos elementos neurais de controle funcional do trato digestivo. Problemas menos técnicos, mas não menos importantes são referentes à necessidade de apoio domiciliar e institucional diferenciado para pacientes freqüentemente restritos ao leito e portadores de deficiências neurológicas severas, em especial considerando os altos índices de pobreza e baixos níveis de educação formal em nosso meio. Escolioses talvez facilitem a ocorrência de DRGE por distorção anatô-mica secundária do diafragma, cardiopatias congênitas graves e síndromes genéticas severas aumentam o risco anestésico do paciente, problemas sociofamiliares graves derivam da necessidade imperativa de cuidados intensivos à criança doente. Desnutrição severa, isolamento social e abandono de emprego de responsáveis ou abandono da própria criança pela família ocorrem freqüentemente. A dificuldade para alimentar portadores de distúrbios de deglutição sem o uso de GT ou cateteres é extrema, e a presença de vômitos e regurgitação alimentar causa dificuldades de convívio para a família e para a criança. Internações hospitalares repetitivas secundárias a doenças respiratórias colaboram para a ruptura de vínculos familiares e matrimoniais e geram grandes despesas para o sistema de saúde e para os pais ou responsáveis em geral.O objetivo deste trabalho é suprir dados quanto aos principais núcleos de debate envolvendo DRGE na criança EP, a fim de estabelecer parâmetros capazes de minorar as dúvidas com respeito à conduta ideal nestas circunstâncias ainda controversas, considerando especialmente as dificuldades encontradas em nosso meio pelas condições sociais adversas infelizmente corriqueiras para o cirurgião que atua em países em desenvolvimento. EPIDEMIOLOGIA E TEORIAS FISIOPATOLÓGICASA DRGE é muito mais freqüente no paciente EP que na criança normal, para qualquer faixa etária considerada, mas as controvérsias que cercam o diagnóstico tornam muito difícil ...

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Effectiveness of fundoplication in early infancy

Cited by 66 publications

References 21 publications

Factors predicting failure of redo Nissen fundoplication in children

Factors predicting failure of redo Nissen fundoplication in children

Clinical and Pulmonary Function Markers of Respiratory Exacerbation Risk in Subjects With Quadriplegic Cerebral Palsy

Refluxo gastroesofágico no paciente encefalopata

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