Short and long-term outcomes after pediatric redo fundoplication

Abstract

Background: Redo fundoplication (RF) is the most common surgical treatment for recurrent gastroesophageal reflux disease (GERD) in children, but outcomes after RF are rarely reported. The aim of this study was to assess short-and long-term outcomes after RF in childhood. Methods: The study is a follow-up study of patients undergoing RF from 2002 to 2020 at a teriary care center. Patients/parents were sent questionnaires recording symptoms of recurrent GERD, troublesome side-effects and satisfaction. Retrospective chart review was also performed. Results: 24/28 (86%) patients were included median 9 (1.6 months-17.7 years) years after RF. 16 (67%) had neurologic impairment. Indications for RF was recurrence of GERD ( n = 18), discomfort or dysphagia from a herniated wrap ( n = 5) and dysphagia from a slipped fundoplication ( n = 1). Median operating time was 128 (95-250) min. Six (25%) patients experienced early major complications, of which two were gastrostomy related. Five (21%) patients experienced recurrence after RF. Three of these were symptom free at follow-up with medical treatment or re-RF. The most common symptom at follow-up was stomach pain (37%) and excessive flatulence (38%). 18/22 (95%) patients/parents would choose RF again, and 21/22 would recommend RF to someone in a similar situation. Conclusions:RF is successful in treating recurrent GERD after primary fundoplication, and patient/parental satisfaction is high.

Fluorescence-Guided Surgery (FGS) during a Laparoscopic Redo Nissen Fundoplication: The First Case in Children

“…The author commented that it was likely that the stomach tissue was partially devitalized during the previous operations, resulting in weak areas that were more susceptible to injury. Conversely, in the series of redo surgeries collected by Kvello et al [ 11 ], half of the patients experienced early postoperative complications. A third of complications were major, with two patients requiring blood transfusions due to intraoperative bleeding.…”

“…Laparoscopic redo surgeries are particularly demanding procedures. The instability of the camera platform, the limited motion of the laparoscopic instruments and two-dimensional (2D) imaging represent a challenge for pediatric surgeons, especially when recurrent hiatal hernias and dense postoperative adhesions significantly alter the anatomy of the esophagogastric junction [ 8 , 9 , 10 , 11 ]. These cases are also associated with the risk of bleeding from the liver and gastric vessels, injury to the vagus nerve, and organ perforation [ 8 , 9 , 10 , 11 ].…”

Long-term outcomes following failure of Nissen fundoplication

“…Fundoplication is currently practised as the operation of choice for treating GORD where medical treatment has been unsuccessful. However, literature is replete with evidence of recurrence of GORD following fundoplication [1,3,4,5,7,9,15,16]. Our previous published studies by Kimber and Spitz et al [5] found redo fundoplication failed to resolve the preoperative symptoms in 20%, with 5/66 children requiring a third fundoplication.…”

“…The chance of success is likely to decrease with every further attempt of fundoplication especially in neurologically impaired children who are more susceptible to post-operative complications [13]. In view of paucity of randomised studies [14,15,16] on long term outcomes of anti-reflux interventions, it is important to explain the pros and cons to the family on individual case by case basis.…”

Total Esophagogastric and Cologastric Dissociation in Neurologically Normal Children: Systematic Review

“…“Re-do” surgery is required in a range of patients between 6% and 14% at 20–36 months of follow-up. Other post-operative problems include high rates of dysphagia, gagging and retching, as well as dumping syndrome and gas bloating [ 4 , 5 ]. Rates of failure of redo-Fundoplication is variable in different series from 21% [ 5 ] to 42% [ 6 ] depending on definitions used, type of patients considered and duration of follow-up.…”