Abstract
Gastroesophageal reflux (GOR) affects 2–8% of children over 3 years of age and is associated with significant morbidity. The disorder is particularly critical in neurologically impaired children, who have a high risk of aspiration. Traditionally, the surgical antireflux procedure of choice has been Nissen's operation. However, this technique has a significant incidence of mechanical complications and has a reoperation rate of approximately 7%, leading to the development of alternative approaches. Watson's technique of partial anterior fundoplication has been shown to achieve long-lasting reflux control in adults with few mechanical complications, but there is limited data in the paediatric population. We present here short- and long-term outcomes of laparoscopic Watson fundoplication in a series of 76 children and infants, 34% of whom had a degree of neurological impairment including severe cerebral palsy and hypoxic brain injury. The overall complication rate was 27.6%, of which only 1 was classified as major. To date, we have not recorded any incidences of perforation and no revisions. In our experience, Watson's laparoscopic partial fundoplication can be performed with minimal complications and with durable results, not least in neurologically compromised children, making it a viable alternative to the Nissen procedure in paediatric surgery.
Highlights
Gastroesophageal reflux (GOR) affects a large number of infants and children
The recognition that the placement of gastrostomy tubes for feeding significantly increases the risk of GOR, together with evidence that reflux may play an important role in the occurrence of apnoeic or bradycardic episodes, sudden death, recurrent chest infections, and chronic reactive airway disease, has resulted in a large increase in antireflux surgery [3]
The degree of reflux was clarified by oesophageal pH and manometry studies, where acid reflux was defined by a Demeester score > 14.72 [13]
Summary
The condition is selflimiting and most patients improve spontaneously over the first years of life. It persists in 2–8% of children aged 2–17 years [1]. Medical therapy is the first line treatment of choice, but surgery remains an option if this fails to control reflux adequately [2]. The recognition that the placement of gastrostomy tubes for feeding significantly increases the risk of GOR, together with evidence that reflux may play an important role in the occurrence of apnoeic or bradycardic episodes, sudden death, recurrent chest infections, and chronic reactive airway disease, has resulted in a large increase in antireflux surgery [3]
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