Surgycal treatment of children with gastroesophageal reflux: 15 years experience

Abstract

Introdactions. Laparoscopic fundoplication for gastroesophageal reflux disease (GERD) is one of the most common procedures performed in children. We have used laparoscopic Nissen fundoplication (LNF) over the past 15 years as the procedure of choice. The aim of this study is to evaluate the effectiveness and long-term results of LNF on a large clinical material. Materials and methods. Since 2001, in 785 children with GERD had LNF performed. The median age was 4.7 years. Weights of children ranged from 2,7 to 120 kg. Long term results were evaluated over 2-15 years after operation. Indications for surgery were ineffective conservative treatment in all cases, severe esophagitis - in 383(56%) children, growth retardation - in 365 (46%), hiatal gernia - in 225 (30%), peptic stenosis - in 123 (15%), respiratory complication - in 143 (18%) children. Severe neurological disorders were found in 324 patients. In 21% GERd was associated with genetic synromes.Analysis of the treatment results tracked the following: 1) intraoperation complications; 2) postoperative complications; and 3) relapse of disease. Treatment results showed the absence of clinical displays of the disease, the knocking over of reflux-esophagitis, and the absence of GERD, according to pH-monitoring. Results. Hyatoplasty was performed in 32% of the cases. And in 39 children with huge hernias of esophageal apertures of a diaphragm a hernial sac excision and hyatoplasty was carried out. The average operating time was 51.3 ± 25.2 minutes. Intraoperative complications occurred in 11 (1.5 %) children (perforation of the stomach – 4, wound of a spleen – 4, pneumothorax – 3, and oppression of heart activity – 1). Postoperative complications developed in 15 (1.9 %) children (mediastinitis – 1, dysphagia – 8, and diarrhea – 6). Intraoperation complications in 2 cases required conversions to open operations. There were no mortalities. In 19 patients simultaneous opearations were performed (thoracoscopic closure of ductus arteriosus, lung resection, etc.). 15 patients were laparoscopicaly operated after failed previous open fundoplications. Good results were achieved in 678 (91,5%) patients. Relapse of the disease were found in 67 patients. In all cases, repeated LNF were performed. The positive results were gained totally in all children with GERD. Conclusion. LNF is a radical method of treatment of GERD in children, which has positive results after primary operation in 92% of cases.