Nissen Fundoplication and Boix-Ochoa Antireflux Procedure: Comparison between Two Surgical Techniques in the Treatment of Gastroesophageal Reflux in Children

Abstract

Over a period of 19 years an antireflux procedure was performed for gastroesophageal reflux in 59 children. Thirty-two patients underwent Nissen fundoplication and 27 children underwent the Boix-Ochoa antireflux procedure. Six patients died between two and 15 months post surgery of unrelated causes. Follow-up period from six months to 18 years was available in 45 (85%) of the surviving patients. This report summarizes the complications and long-term results with the two surgical procedures and their comparisons. The follow-up evaluation included parental interview and physical examination. Upper GI series and pH monitoring were performed only in children with signs and symptoms of recurrent GER or other post-operative complications. At follow-up with a mean period of 8.7 years following Nissen fundoplication, 87.5% showed good results without any residual symptoms. However, the overall complication rate was as high as 50%. Following the Boix-Ochoa antireflux procedure, 17 (81%) children showed excellent results while four children had recurrent GER. This occurred in two neurologically impaired children and two patients following esophageal atresia repair. No other post-operative complications were encountered with the Boix-Ochoa antireflux procedure. In our experience, the Boix-Ochoa antireflux procedure should be the procedure of choice in the surgical treatment of GER in otherwise normal children while the Nissen fundoplication is preferable in neurologically impaired children and in patients with GER following esophageal atresia repair.

Recurrent gastroesophageal reflux in neurologically impaired patients after fundoplication

“…Several theories have been proposed over the last years about the main causes of postoperative recurrent reflux in NIP. First, the type of surgery (24,25), had no effect on the overall incidence of recurrent reflux in our study. However, we found recurrence of reflux occurring significantly earlier when a vSF was performed when compared with NF or dSF (8 months vs. 48 months vs. 24 months).…”

Parents reported reduced symptoms and improved satisfaction after fundoplication and their perceptions were an important outcome measure

“…The primary operative procedure was an anterior partial fundoplication as described by Thal in 22 patients (9) with another 12 patients undergoing Nissen fundoplication (8). This was more frequent in children with neurological impairment (60%) and children with other gastrointestinal disorders (57%).…”

Long-term outcome of laparoscopic Nissen-Rossetti fundoplication versus Thal fundoplication in children with esophageal hiatal hernia: a retrospective report from two children’s medical centers in Shanghai

“…However, surgeons do not agree on the best antireflux procedure. Cohen et al [12] recommended a total 360-degree fundoplication for neurologically impaired children, and partial fundoplication for neurologically normal children, while another group prefers partial fundoplication for all children with GERD. [13] In recent years, we have used the different procedures based on our patients' conditions.…”