A comparison of Nissen fundoplication and Boerema gastropexy in the surgical treatment of gastro-oesophageal reflux in children

Abstract

The results of surgical treatment of gastro-oesophageal reflux in 133 infants and children clearly demonstrated the superiority of the Nissen fundoplication over the Boerema gastropexy. The failure to control reflux in the gastropexy group (50 patients) was 42 per cent compared with a 9.6 per cent failure rate in the fundoplication group (83 patients). This resulted in a reoperation rate of 24 per cent for the gastropexy procedure compared with 8 per cent for the fundoplication. There was no difference in the incidence of postoperative complications.

Long‐Term Results of Boerema Anterior Gastropexy in Children

“…Our overall complication rate of 23% and the postoperative death rate are difficult to compare with other studies (2,4‐8). In the latter studies, the patients included were heterogeneous with regard to age, severity of GERD, indication for operation, presenting symptoms, associated conditions and duration of follow‐up.…”

“…The allegedly poor reputation of anterior gastropexy is therefore not sustained by our results. The explanation for the high recurrence rate after gastropexy in other series (2,9) is probably a matter of technical detail. Adequate dissection of the esophagus in the hiatus and mobilization of a 5-cm segment into the abdomen is essential to obtain a high pressure zone.…”

“…Various surgical antireflux procedures are performed in children (2,4‐8). Anterior gastropexy as described by Boerema has been found successful for treating GER in children (9‐13).…”

“…Anterior gastropexy as described by Boerema has been found successful for treating GER in children (9‐13). However, 1 study found a failure rate in the gastropexy group of 42% compared with 10% failure in the fundoplication group (2); whereas another study advised that anterior gastropexy was only effective in uncomplicated patients (14). The purpose of this study was to investigate the long‐term results of anterior gastropexy using the Visick grading system through questionnaires by telephone and compare these to the reported results of other antireflux procedures.…”

Modified Toupet Wrap for Gastroesophageal Reflux in Childhood

“…We observed postoperative comphcations in 3 children (13.6%) and all complications were managed non-operatively. In contrast, De Laet reported a complication rate of 24.8 % for Boerema and Nissen fundoplications in children and Turnage reported a complication rate of 45 % for Nissen fundoplications in infants and children (5,19). Wilkins reported in 1987 an adhesion obstruction rate of 10.3 % foilowing Nissen fundoplications in children and warned that "presenting symptoms were not typical of intestinal obstruction because many children were unable to vomit" and she found that only 3 of these 16 patients (19 %) did vomit but all had radiological appearances suggestive of small bowel obstruction (22).…”