Faculty Collaboration Database

Redo fundoplication in infants and children with recurrent gastroesophageal reflux. J Pediatr Surg 1991 Jul;26(7):758-61

Date

07/01/1991

Pubmed ID

1910081

DOI

10.1016/0022-3468(91)90132-d

Scopus ID

2-s2.0-0025913554 (requires institutional sign-in at Scopus site)   52 Citations

Abstract

The Nissen fundoplication is well established as the surgical treatment for medically refractory gastroesophageal reflux (GER) in childhood. Recurrent GER following fundoplication is a challenging problem with a reported incidence ranging from 0% to 12%. From January 1974 to January 1989, 286 children have been treated for GER with Nissen fundoplication and gastrostomy tube placement at the University of Michigan C.S. Mott Children's Hospital; 242 of these children have been followed for an average of 30 months, the remaining 44 have been lost to follow-up. Twenty-nine children (12%) have developed recurrent reflux following fundoplication. Medical management with thickened upright feelings, gastrostomy feedings, or gastrojejunostomy tube feedings has been successful for 11 children with control of reflux symptoms. Five additional children who were treated nonoperatively died of coexistant medical problems within 2 months following documentation or recurrent reflux. The remaining 13 children have required redo fundoplication for wrap disruption or herniation, and an additional six children, initially treated at other institutions, have also undergone redo fundoplications. One other child treated at this hospital required redo fundoplication for a postoperative partial gastric volvulus causing gastric outlet obstruction. Of the 20 children who have undergone a second Nissen fundoplication, 16 (80%) are doing well without recurrent GER. Four children have developed recurrent GER with wrap disruption; 1 is doing well following a third fundoplication, 2 have been managed successfully with continuous feedings via gastrojejunostomy feeding tubes, and a fourth child died of complications related to a recurrent tracheoesophageal fistula. Conservative management with gastrojejunal tube feedings should be considered in the initial management of children with recurrent GER following fundoplication.(ABSTRACT TRUNCATED AT 250 WORDS)

Author List

Wheatley MJ, Coran AG, Wesley JR, Oldham KT, Turnage RH

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Enteral Nutrition
Esophagus
Female
Gastric Fundus
Gastroesophageal Reflux
Humans
Infant
Male
Postoperative Care
Postoperative Complications
Recurrence