DOZ047.54: Fundoplication outcomes in children with esophageal atresia

Abstract

Abstract Background In esophageal atresia (EA) patients, cumulative risk of having a fundoplication ranges from 0% to 45%, with long gap patients with recurrent strictures at even higher risk. However, there are no controlled trials evaluating the outcomes postfundoplication. We hypothesized that children with EA undergoing fundoplication will suffer from more postoperative dysphagia compared to non-EA patients as the fundoplication increases the resistance to esophageal bolus flow, which is already hampered by abnormal motility. Aims Our study aimed to compare outcomes in EA patients with age- and sex-matched control patients postfundoplication. Methods This was an international multicenter retrospective cohort study. All EA patients who had fundoplication between 2006 and 2017 during this period were included. Data were also collected from age- and sex-matched children without EA who underwent fundoplication. Results A total of 40 EA patients had fundoplication during this period. Of the EA patients 82.5% were type C, and 82.5% were long gap. Table 1 compares EA patients with controls. Significantly more EA patients were failing to thrive, on nasogastric/gastrostomy feeds at time of surgery and needed gastrostomy placement at time of fundoplication compared to controls. A total of 17.5% of EA patients developed infection and 22.5% a leak postfundoplication. EA patients had postoperative dysphagia and oral aversion significantly more often than controls. Of 90% of EA patients had recurrence of gastrointestinal or respiratory symptoms, 35% had recurrent strictures, 5% had a new diagnosis of eosinophilic esophagitis postfundoplication. Median time to symptom recurrence was 64 days (12–165 days), 90% were back on PPI and 7.5% had redofundoplication. Conclusions Our study is the first to examine postfundoplication outcomes in EA patients and compare these with a matched control group. EA patients had significantly more dysphagia and oral aversion postfundoplication and majority were back on PPI within two months of surgery. Based on these data, the role of fundoplication in EA patients should be reconsidered. Prospective data are urgently needed.