Gastric emptying in children with gastroesophageal reflux. II. The relationship to retching symptoms following antireflux surgery

Jolley, Stephen G.; Tunell, William P.; Leonard, Joe C.; Hoelzer, Dennis J.; Smith, E. Ide

doi:10.1016/s0022-3468(87)80591-2

Cited by 46 publications

(22 citation statements)

References 12 publications

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“…In particular, retching is a common problem following Nissen fundoplication and it is been reported in a high percentage (50%) of children requiring redo fundoplication for recurrent reflux. Retching is associated with disturbed gastricelectrical control activity [16], alterations in gastric emptying [17][18][19], and may be related to vagal nerve dysfunction following Nissen fundoplication [16]. Persistent retching might itself lead to wrap disruption due to an increased pressure on the wrap.…”

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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“…Preoperative delayed gastric emptying is protective against postoperative early satiety [51] but is a risk factor for paraesophageal hernia [40] and for retching postoperatively [54]. Postoperative persistence of delayed gastric emptying is also a risk factor for retching [54]. Delayed gastric emptying with onset after antireflux surgery may be caused by inadvertent vagal nerve injury.…”

Section: Important Features To Note On Videofluoroscopic Assessmentmentioning

confidence: 99%

Gastrointestinal complications of fundoplication

Connor

2005

Curr Gastroenterol Rep

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In children with medically refractory gastroesophageal reflux disease (GERD), fundoplication is effective and safe. However, in a subset of patients, gastrointestinal dysfunction occurs postoperatively. Symptoms include chest pain, persistent dysphagia in 5%, gas bloat in 2% to 4%, diarrhea in up to 20%, and dumping syndrome in up to 30%. Symptoms are often nonspecific, arising from recurrent or persistent GERD, anatomic complications such as disrupted or herniated wrap, functional disturbances such as rapid gastric emptying or altered gastric accommodation, or alternative diagnoses such as cyclic vomiting syndrome or food allergy. Detailed investigation, including various combinations of pHmetry, videofluoroscopy, endoscopy, motility studies, and dumping provocation testing, may be required to clarify pathophysiology and guide management.

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“…In six of the twelve patients Jolley et al described with postoperative retching, dumping syndrome was not present and symptoms were attributed to decreased gastric emptying [14]. Some authors have suggested that performing a gastric outlet procedure to facilitate gastric emptying may lessen the incidence of postoperative retching [16].…”

Section: Discussionmentioning

confidence: 94%

“…While neither Harnsberger et al nor Negre mention these distressing symptoms, Stringel et al observed retching in 13% of 90 children with neurologic impairment following fundoplication [9], and Jolley et al noted postoperative retching in 18% of the 66 children he evaluated [ 14]. In six ofJolley et al's twelve patients the retching was attributed to postoperative dumping syndrome.…”

Section: Discussionmentioning

confidence: 99%

Oral dysfunction following nissen fundoplication

Borowitz

1992

Dysphagia

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In this case report we describe a child with mild neurologic impairment who developed debilitating gagging and retching, and severe oral-motor dysfunction following Nissen fundoplication and gastrostomy tube placement. All oral intake ceased after the operation. Evaluation for postoperative dumping syndrome was negative, and the child's symptoms failed to improve despite numerous medical and surgical measures. However, immediately following reversal of the Nissen fundoplication, the child's gagging and retching ceased, and his oral-motor function began to improve. This is a previously undescribed complication of Nissen fundoplication, a surgical procedure commonly employed in children with neurologic impairment.

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Gastric emptying in children with gastroesophageal reflux. II. The relationship to retching symptoms following antireflux surgery

Cited by 46 publications

References 12 publications

Factors predicting failure of redo Nissen fundoplication in children

Factors predicting failure of redo Nissen fundoplication in children

Gastrointestinal complications of fundoplication

Oral dysfunction following nissen fundoplication

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