Gastroesophageal reflux disease in children: efficacy of Nissen fundoplication in treating digestive and respiratory symptoms. Experience of a single center

Abstract

Fundoplication has been commonly performed in neurologically impaired and normal children with complicated gastroesophageal reflux disease. The relationship between gastroesophageal reflux disease and respiratory diseases is still unclear. We aimed to compare results of open and laparoscopic procedures, as well as the impact of fundoplication over digestive and respiratory symptoms. From January 2000 to June 2007, 151 children underwent Nissen fundoplication. Data were prospectively collected regarding age at surgery, presence of neurologic handicap, symptoms related to reflux (digestive or respiratory, including recurrent lung infections and reactive airways disease), surgical approach, concomitant procedures, complications, and results. Mean age was 6 years and 9 months. Eighty-two children (54.3%) had neurological handicaps. The surgical approach was laparoscopy in 118 cases and laparotomy in 33. Dysphagia occurred in 23 patients submitted to laparoscopic and none to open procedure (P = 0.01). A total of 86.6% of patients with digestive symptoms had complete resolution or significant improvement of the problems after the surgery. A total of 62.2% of children with recurrent lung infections showed any reduction in the frequency of pneumonias. Only 45.2% of patients with reactive airway disease had any relief from bronchospasm episodes after fundoplication. The comparisons demonstrated that Nissen fundoplication was more effective for the resolution of digestive symptoms than to respiratory manifestations (P = 0.04). Open or laparoscopic fundoplication are safe procedures with acceptable complication indices and the results of the surgery are better for digestive than for respiratory symptoms.

Clinical and Pulmonary Function Markers of Respiratory Exacerbation Risk in Subjects With Quadriplegic Cerebral Palsy

“…21 Our results have led us to speculate, although we do not have direct data as proof, that gastroesophageal reflux contributes to an increased exacerbation frequency in children with CP by causing aspiration into the lower airways. Given the efficacy of Nissen fundoplication in treating gastroesophageal reflux-related digestive and respiratory disturbances in chronically ill children, [31][32][33] it probably seems counterintuitive that, in our experience, subjects undergoing this type of anti-reflux surgery show no significant improvement: their exacerbation risk is similar to that of subjects who have not undergone the procedure. Indeed, the results of our study agree with previous data demonstrating that Nissen fundoplication does not lead to improvement in respiratory disturbances in ϳ50% of neurologically impaired children.…”

Laparoscopic fundoplication for gastroesophageal reflux disease in infants and children

“…Thus, GERD and airway disease, including aspiration pneumonia, are considered to be strongly related, 25 although Kawahara et al and Tannuri et al both reported recently that antirefl ux surgery is effective for controlling emesis, but is not considered responsible for the relief of bronchospastic syndromes. 15,26 This might accentuate the need for more accurate investigation of the infl uence of GERD on respiratory disease.…”

“…The incidence of dysphagia is higher after laparoscopy than after open surgery because the dysphagia is thought to be related to more extensive dissection of the abdominal esophagus and hiatus, leading to local edema. 26 For this reason, the symptom is usually transitory. There was no signifi cant difference in early complication rates between the open and laparoscopy surgery groups, but the laparoscopy group had a signifi cantly lower late complication rate.…”

Does Nissen fundoplication improve deglutition in children?

“…Since 95% of patients did no show GER findings in postoperative UGI and 24-hour pH studies, we suggest that decreased penetration and aspiration can be explained by decreased reflux episodes. It has been suggested that NF is more effective for resolution of digestive symptoms than respiratory functions 15 . Decreased risk of aspiration may be responsible for better respiratory functions after fundoplication.…”

“…Retrospective studies demonstrate that fundoplication is responsible for relief in respiratory symptoms in 45% of patients 15 .…”