Abstract
Although laparoscopic Nissen fundoplication is the standard surgical treatment for gastroesophageal reflux disease (GERD), surgical complications and postoperative pain are not uncommon, especially for those patients who are neurologically impaired (NI) or undergoing reoperative procedures. To address this challenge, the authors utilized the transoral incisionfess fundoplication (TIF) procedure to treat GERD via an endoscopic approach. Eleven TIF patients were included with an average age of 16.5 ± 5.1 years and weight of 45.7 ± 13.3 kg. NI was present in nine patients (82%), including a predominant number of patients with a history of seizures and gastrostomy tube feeding. Five patients had a history of a previous failed fundoplication requiring a reoperative procedure (45%). A retrospective chart review evaluated patient outcomes and postoperative complications. The length of the TIF procedure was 113.3 ± 31.3 minutes with minimal blood loss. The length of stay was 1.2 ± 0.4 days, although 1 TIF patient was readmitted for endoscopic clipping for gastric bleeding. At a follow-up of 8.2 ± 4.2 months, TIF effectively resolved GERD in 10 of 11 children. A few of the patient's families reported complaints of gagging or dysphagia (30%; 3/11); however, it was difficult to determine if complaints were caused by the procedures itself or baseline NI. All patients who had a follow-up upper GI or pH probe study showed no evidence of reflux. One TIF patient had no recurrent reflux but required an esophagogastric disconnection for retching. The TIF procedure can complement the current surgically and medically available options for children with GERD, especially in complicated patients such as those with NI. However, complications including hemorrhage emphasize the potential risk of the procedure. Further studies with more patients and a longer follow-up course must be conducted to better assess efficacy.
Published Version
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