Short and long-term outcomes after pediatric redo fundoplication

Morten Kvello,Charlotte K Knatten,Thomas J Fyhn,Kristin Bjørnland

doi:10.1016/j.jpedsurg.2021.05.012

Morten Kvello, Charlotte K Knatten + Show 2 more

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https://doi.org/10.1016/j.jpedsurg.2021.05.012

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Abstract

BackgroundRedo fundoplication (RF) is the most common surgical treatment for recurrent gastroesophageal reflux disease (GERD) in children, but outcomes after RF are rarely reported. The aim of this study was to assess short- and long-term outcomes after RF in childhood. MethodsThe study is a follow-up study of patients undergoing RF from 2002 to 2020 at a teriary care center. Patients/parents were sent questionnaires recording symptoms of recurrent GERD, troublesome side-effects and satisfaction. Retrospective chart review was also performed. Results24/28 (86%) patients were included median 9 (1.6 months–17.7 years) years after RF. 16 (67%) had neurologic impairment. Indications for RF was recurrence of GERD (n = 18), discomfort or dysphagia from a herniated wrap (n = 5) and dysphagia from a slipped fundoplication (n = 1). Median operating time was 128 (95–250) min. Six (25%) patients experienced early major complications, of which two were gastrostomy related.Five (21%) patients experienced recurrence after RF. Three of these were symptom free at follow-up with medical treatment or re-RF. The most common symptom at follow-up was stomach pain (37%) and excessive flatulence (38%). 18/22 (95%) patients/parents would choose RF again, and 21/22 would recommend RF to someone in a similar situation. ConclusionsRF is successful in treating recurrent GERD after primary fundoplication, and patient/parental satisfaction is high.

Highlights

Fundoplication is one of the most commonly performed major gastrointestinal surgical procedures in pediatric patients
The primary fundoplications were performed according to the Nissen technique, and hiatal closure was performed in all
This study on short and long-term outcome after Redo fundoplication (RF) in childhood demonstrates that most patients were successfully treated for their recurrent gastroesophageal reflux disease (GERD)

Summary

Introduction

Fundoplication is one of the most commonly performed major gastrointestinal surgical procedures in pediatric patients. Indications for fundoplication are symptoms or complications of gastroesophageal reflux (GER) disease (GERD) not sufficiently relieved with conservative treatment [1]. A systematic review from 2011 including studies with at least six months follow-up after primary fundoplication, reported recurrence of symptoms in 4–30% [2]. Treatment options include conservative management, redo fundoplication (RF), jejunal feeding either through a transgastric jejunal (TGJ) tube or a jejunostomy, Abbreviations: GER, gastroesophageal reflux; GERD, gastroesophageal reflux disease; NI, neurologic impairment; RF, redo fundoplication; TGJ, transgastric jejunal; UGI, upper gastrointestinal. Redo fundoplication (RF) is the most common surgical treatment for recurrent gastroesophageal reflux disease (GERD) in children, but outcomes after RF are rarely reported. Five (21%) patients experienced recurrence after RF Three of these were symptom free at follow-up with medical treatment or re-RF. Conclusions: RF is successful in treating recurrent GERD after primary fundoplication, and patient/parental satisfaction is high

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