Thal fundoplication for pediatric gastroesophageal reflux disease.

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ALTHOUGH some gastroesophageal reflux (GER) is normal and some patients tolerate even large amounts of GER without any complications, a subset of patients have the complications of GER that result in a disease state known as gastroesophageal reflux disease, (GERD) which is a consideration for medical or surgical intervention. Medical treatment that alters esophageal motility, promotes gastric emptying, and reduces gastric acid production may ameliorate the symptoms of reflux. Many patients respond poorly to medical therapy or find the medications intolerable. Many are just not compliant. For GER complications such as recurrent pneumonitis, acute life-threatening events (ALTE), unremitting vomiting, and failure to thrive, surgical treatment offers a lasting cure (95+%). The partial anterior fundoplication as described by ThaI is our operation of choice. We believe it is as effective as a complete wrap in eliminating reflux and that it has fewer complications such as gas bloat and adhesive intestinal obstruction. Surgical treatment of GERD is perhaps more effective in children than in adults, and therefore surgery is used more often for pediatric patients with significant GER. All surgical fundoplication procedures are based on the principle of establishment of an intraabdominal portion of the esophagus coupled with plication of the stomach to the lower esophagus to establish an angle of His, thus creating an antireflux mechanism. The most commonly performed surgical procedure is the 360-degree wrap described by Nissen. l We prefer the 180-degree wrap described by ThaF (Table 1).