“…1). 6–23Fig. 1Flow chart illustrating details of selection of studies on results of anti-reflux surgery in children…”
Section: Resultsmentioning
confidence: 99%
“…Only two RCTs were identified, and only five articles used control groups to verify their results 6,8–10,14,23. Most studies used standardized surgical methods and investigation techniques and reported adequate on lost to follow-up.…”
BackgroundAntireflux surgery (ARS) for gastroesophageal reflux disease (GERD) is one of the most frequently performed major operations in children. Many studies have described the results of ARS in children, however, with a wide difference in outcome. This study aims to systematically review the efficacy of pediatric ARS and its effects on gastroesophageal function, as measured by gastroesophageal function tests. This is the first systematic review comprising only prospective, longitudinal studies, minimizing the risk of bias.MethodsThree electronic databases (Medline, Embase, and the Cochrane Library) were searched for prospective studies reporting on ARS in children with GERD.ResultsIn total, 17 eligible studies were identified, reporting on a total of 1,280 children. The median success rate after ARS was 86% (57–100%). The success rate in neurologically impaired children was worse in one study, but similar in another study compared to normally developed children. Different surgical techniques (total versus partial fundoplication, or laparoscopic versus open approach) showed similar reflux recurrence rates. However, less postoperative dysphagia was observed after partial fundoplication and laparoscopic ARS was associated with less pain medication and a shorter hospital stay. Complications of ARS varied from minimal postoperative complications to severe dysphagia and gas bloating. The reflux index (RI), obtained by 24-h pH monitoring (n = 8) decreased after ARS. Manometry, as done in three studies, showed no increase in lower esophageal sphincter pressure after ARS. Gastric emptying (n = 3) was reported either unchanged or accelerated after ARS. No studies reported on barium swallow x-ray, endoscopy, or multichannel intraluminal impedance monitoring before and after ARS.ConclusionARS in children shows a good overall success rate (median 86%) in terms of complete relief of symptoms. Efficacy of ARS in neurologically impaired children may be similar to normally developed children. The outcome of ARS does not seem to be influenced by different surgical techniques, although postoperative dysphagia may occur less after partial fundoplication. However, these conclusions are bound by the lack of high-quality prospective studies on pediatric ARS. Similar studies on the effects of pediatric ARS on gastroesophageal function are also very limited. We recommend consistent use of standardized assessment tests to clarify the effects of ARS on gastroesophageal function and to identify possible risk factors for failure of ARS in children.
“…1). 6–23Fig. 1Flow chart illustrating details of selection of studies on results of anti-reflux surgery in children…”
Section: Resultsmentioning
confidence: 99%
“…Only two RCTs were identified, and only five articles used control groups to verify their results 6,8–10,14,23. Most studies used standardized surgical methods and investigation techniques and reported adequate on lost to follow-up.…”
BackgroundAntireflux surgery (ARS) for gastroesophageal reflux disease (GERD) is one of the most frequently performed major operations in children. Many studies have described the results of ARS in children, however, with a wide difference in outcome. This study aims to systematically review the efficacy of pediatric ARS and its effects on gastroesophageal function, as measured by gastroesophageal function tests. This is the first systematic review comprising only prospective, longitudinal studies, minimizing the risk of bias.MethodsThree electronic databases (Medline, Embase, and the Cochrane Library) were searched for prospective studies reporting on ARS in children with GERD.ResultsIn total, 17 eligible studies were identified, reporting on a total of 1,280 children. The median success rate after ARS was 86% (57–100%). The success rate in neurologically impaired children was worse in one study, but similar in another study compared to normally developed children. Different surgical techniques (total versus partial fundoplication, or laparoscopic versus open approach) showed similar reflux recurrence rates. However, less postoperative dysphagia was observed after partial fundoplication and laparoscopic ARS was associated with less pain medication and a shorter hospital stay. Complications of ARS varied from minimal postoperative complications to severe dysphagia and gas bloating. The reflux index (RI), obtained by 24-h pH monitoring (n = 8) decreased after ARS. Manometry, as done in three studies, showed no increase in lower esophageal sphincter pressure after ARS. Gastric emptying (n = 3) was reported either unchanged or accelerated after ARS. No studies reported on barium swallow x-ray, endoscopy, or multichannel intraluminal impedance monitoring before and after ARS.ConclusionARS in children shows a good overall success rate (median 86%) in terms of complete relief of symptoms. Efficacy of ARS in neurologically impaired children may be similar to normally developed children. The outcome of ARS does not seem to be influenced by different surgical techniques, although postoperative dysphagia may occur less after partial fundoplication. However, these conclusions are bound by the lack of high-quality prospective studies on pediatric ARS. Similar studies on the effects of pediatric ARS on gastroesophageal function are also very limited. We recommend consistent use of standardized assessment tests to clarify the effects of ARS on gastroesophageal function and to identify possible risk factors for failure of ARS in children.
“…Shorter hospital stays and decreased requirements for pain medications are seen with minimally invasive approaches [ 16 ]. Dysphagia is less common for partial vs. complete fundoplication [ 29 ]. In a randomized trial comparing Nissen and Thal fundoplications in children, there were no differences in short-term outcomes at 6 weeks after surgery, although dysphagia was more severe in children who underwent a Nissen fundoplication [ 30 ].…”
Section: Surgical Therapy For Pediatric Gerdmentioning
“…14,15 In adults, it has been established that, compared to Nissen fundoplication, laparoscopic partial fundoplication causes less dysphagia, gas bloating and redo surgeries [16][17][18] Similar to adult findings, pediatric observations suggested that total and partial fundoplication produce equivalent GER control in children 19 dysphagia may occur less frequently in partial versus total fundoplications. 20 These conclusions are however based on limited data and uncertainty remains with respect to the optimal fundoplication technique. In addition prospective evidence is limited in terms of efficacy and complication rates between partial and total fundoplication.…”
Introduction
Gastroesophageal reflux disease and treatment in childrenGastroesophageal reflux disease (GERD) in children is common, it affects approximately (?)3% of infants and <1% of older children. 1 GERD is clinically diagnosed when gastroesophageal reflux (GER) causes troublesome symptoms, and is a source of stress for both patients and caregivers. In infants, GERD is often mild and short lived, with >90% being free of GERD symptoms at the age of 18 months. 2,3 'Symptomatic GERD', that is a clinical diagnosis of GERD without corroborative evidence such as endoscopic evidence of esophagitis, can be challenging to treat. Standard treatment consists firstly of conservative measures: lifestyle changes, excess weight reduction, no exposure to tobacco smoke. In specific cases allergies are associated with GERD, and avoidance of allergens may relieve symptoms.If pharmacological therapy is considered, acid suppression is the first choice and using proton pump inhibitors (PPIs) is favored above H2-antagonists and on demand buffering agents. 2 However, acid suppression therapy in infants and children is now widely discouraged as PPIs, whilst proven effective in increasing gastric pH, do not reduce GERD symptoms. 4 The lack of therapeutic efficacy of acid suppressive therapy might be explained by the fact that acid suppression does not target the underlying mechanism of reflux which is transient lower sphincter relaxation (TLESR). 3,5 Acid suppression only turns acid GER into weakly acid GER, which may still cause troublesome symptoms. Although other therapeutic agents are being developed for adult GERD treatment (especially GABA(B) agonists and mGLUR5 antagonists), these have many sideeffects and are not yet tested in children. 6,7 Therefore, no pharmacological interventions aimed a reducing TLESRs are available.In patients with objective evidence of acid-related GERD, based on upper endoscopy, pH-metry and/or pH impedance measurement (pHMII), who experience severe symptoms or have esophagitis refractory to optimal medical therapy, anti-reflux surgery (fundoplication) may be a treatment of last resort. 8Indications for fundoplication are poorly defined in children 2,9,10 and there is no uniformity between hospitals in the approach to infants and children with pharmacological therapy resistant GERD. 11 Neurologically impaired children, children with a history of esophageal atresia 12 and children with respiratory alarm symptoms considered GERD-related (e.g. apnea, bronchiectasis, recurrent pneumonia) are more prone to undergo fundoplication.
Fundoplication techniquesThe primary goal of anti-reflux surgery is to reduce GER without preventing passage into the stomach of swallowed substances. These conclusions are however based on limited data and uncertainty remains with respect to the optimal fundoplication technique. In addition prospective evidence is limited in terms of efficacy and complication rates between partial and total fundoplication. 19
Efficacy and safety of fundoplicationEfficacy and safety o...
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