Long-term outcome and need of re-operation in gastro-esophageal reflux surgery in children.

Abstract

Fundoplication is considered a mainstay in the treatment of gastro-esophageal reflux. However, the literature reports significant recurrences and limited data on long-term outcome. To evaluate our long-term outcomes of antireflux surgery in children and to assess the results of redo surgery. We retrospectively analyzed all patients who underwent Nissen fundoplication in 8 consecutive years. Reiterative surgery was indicated only in case of symptoms and anatomical alterations. A follow-up study was carried out to analyzed outcome and patients' Visick score assessed parents' perspective. Overall 162 children were included for 179 procedures in total. Median age at first intervention was 43months. Comorbidities were 119 (73%), particularly neurological impairments (73%). Redo surgery is equal to 14% (25/179). Comorbidities were risk factors to Nissen failure (p=0.04), especially children suffering neurological impairment with seizures (p=0.034). Follow-up datasets were obtained for 111/162=69% (median time: 51months). Parents' perspectives were excellent or good in 85%. A significant positive impact of redo Nissen intervention on the patient's outcome was highlighted; antireflux surgery is useful and advantageous in children and their caregivers. Children with neurological impairment affected by seizures represent significant risk factors.