Variations in preoperative decision making for antireflux procedures in pediatric gastroesophageal reflux disease: a survey of pediatric surgeons

LaRiviere, Cabrini A.; Parimi, Chinnaya; Huaco, Jorge C.; Acierno, Stephanie A.; Garrison, Michelle M.; Goldin, Adam B.

doi:10.1016/j.jpedsurg.2011.03.035

Cited by 23 publications

(10 citation statements)

References 15 publications

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“…Unfortunately, making reference to the published results on this topic we are not able to guarantee these outcomes to patients' families, so far. Most paediatric surgeons when have to decide about the need for surgery do not perform preoperative investigations other than a review of the clinical history and physical examination, taking decisions based only on symptomatic assessment and failure to respond to medical therapy 18 . Moreover, there is no gold standard technique to diagnose GERD in children with NI.…”

Section: Discussionmentioning

confidence: 99%

Nissen fundoplication and combined procedures to reduce recurrence of gastroesophageal reflux disease in neurologically impaired children

Ceriati

Marchetti

Caccamo

et al. 2020

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Neurologically impaired children account for almost half of the fundoplication procedures performed for gastroesophageal reflux disease. Aim of the present study was to report results of antireflux surgery in neurologically impaired children. A retrospective study of neurologically impaired children who underwent fundoplication over a 13-year period (1999-2012) was performed. Recurrence rate, major complications and parents/caregivers perceptions of their child's quality of life following antireflux surgery were analyzed. A total of 122 children (median age: 8 years 9 months; range: 3 months to 18 years) had open "tension-free" Nissen fundoplication, gastrostomy + /− pyloroplasty. Gastroesophageal reflux disease was in all cases documented by at least two diagnostic exams. Median duration of follow-up was 9.7 (1.9-13) years. Three (2.4%) recurrences were documented and required surgery redo. Major complications were 6%. Seventy-nine of 87 (90%) caregivers reported that weight gain was improved after fundoplication with a median score of 1 (IQR: 1-2). Significant improvement was perceived in postoperative overall quality of life. In this series of fundoplication recurrence incidence was low, serious complications were uncommon and caregivers' satisfaction with surgery was high. Accurate patient's selection and creating a "low-pressure" surgical system are mandatory to obtain these results.

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Section: Discussionmentioning

confidence: 99%

Nissen fundoplication and combined procedures to reduce recurrence of gastroesophageal reflux disease in neurologically impaired children

Ceriati

Marchetti

Caccamo

et al. 2020

Sci Rep

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“…Regardless of the evidence for or against specific objective studies, surveys indicate that physician practice varies widely regarding the application of these tests, and individual provider gestalt still plays a major role in the decision to offer ARP. [22][23][24] The results of our study suggest that health care providers are more likely to offer an ARP to infants relative to older children independent of other commonly considered indications for fundoplication in children. The reasons for the difference are unclear but are likely influenced by the high rates of physiologic regurgitation and the diagnostic conundrum in this population, the use of fundoplication as part of a durable feeding plan in infants with failure to thrive, and a greater concern about the potential complications of untreated GERD in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Antireflux Procedures for Gastroesophageal Reflux Disease in Children

et al. 2014

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Of the 141,190 patients meeting study criteria, 11,621 (8.2%) underwent ARPs during the study period. More than half of patients undergoing ARPs (52.7%) were 6 months or younger. Although most patients in the ARP group had preoperative upper gastrointestinal tract fluoroscopy (65.0%), these patients did not undergo a uniform workup. The hazard of progression to an ARP was significantly decreased in children aged 7 months to 4 years (hazard ratio, 0.63 [P < .001]) and 5 to 17 years (0.43 [P < .001]) relative to children younger than 2 months. Hazard ratios were independently increased for comorbid diagnoses of failure to thrive, neurodevelopmental delay, cardiopulmonary anomalies, cerebral palsy, and aspiration pneumonia and among patients with tracheoesophageal fistula and diaphragmatic hernia. Each additional GERD-related hospitalization was associated with a 10% increased risk of an ARP. CONCLUSIONS AND REVELANCE: Antireflux procedures are most commonly performed in children during a period of life when regurgitation is normal and physiologic and objective measures of GERD are difficult to interpret. To identify meaningful outcomes after ARP, indications must be clear and standardized. We must clarify the appropriate workup for infants and young children with GERD and better define "failure of medical management" in this population.

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“…20 No entanto, na presença de DRGE impõe-se uma atitude ativa dadas as possíveis complicações. 4,15,20 A abordagem da DRGE pode implicar a realização de cirurgia antirrefluxo. As indicações operatórias não são unânimes.…”

Section: Discussionunclassified

“…6,[9][10][11][12][13] A cirurgia antirrefluxo é um procedimento frequente- mente realizado em centros de cirurgia pediátrica terciários. 6,8,[12][13][14][15][16][17][18] A abordagem operatória pode ser realizada por via clássica (laparotomia) ou por via laparoscópica, embora a embora a última seja assumida pela grande maioria dos autores como gold standard. 6,9,10,16,17,19 Vários estudos têm demonstrado a eficácia e segurança da fundoplicatura por via laparoscópica realizada em crianças, com as vantagens inerentes a este tipo de abordagem.…”

Section: Introductionunclassified

Cirurgia Laparoscópica do Refluxo Gastroesofágico na Criança

et al. 2013

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Introduction: Gastroeshophageal reflux is a common but usually innocuous condition in children. However, in the presence of Gastroeshophageal reflux disease, the surgical treatment (open or laparoscopic) may be indicated. This study aimed to evaluate the feasibility, effectiveness and safety of laparoscopic antireflux surgery (Nissen fundoplication) with emphasis in infants.Material and Methods: Children with gastroeshophageal reflux proposed for laparoscopic antireflux surgery between January 2006 and December 2012 in a pediatric surgery department of a university hospital were studied. A descriptive and comparative analysis was conducted with regard to age (group I: <1 year, group II: 1-3 years, group III: > 3 years) and presence of comorbidities. Demographics, symptoms, comorbidities, operative indications, perioperative and postoperative outcome were assessed. The statistical significance level was set at 5%.Results: 55 children were proposed for surgery: 12 of group I, 15 group of II and 28 of group III. 50.9% had comorbidities (21 central nervous system disease and 7 esophageal atresia). In 52 (94.5%) cases, antireflux surgery was performed by laparoscopy. The procedure lasted 167 ± 42 minutes, with no significant differences according to age groups, although higher in those with central nervous system disease. With a follow-up of 35.5 ± 23.9 months, the following complications occurred: gas-bloat syndrome, dumping or dysphagia in 8 cases (15.7%) and paraesophageal hernia in 2 cases (3.9%), with no significant differences between groups; there was clinical recurrence with reoperation in 2 cases.Conclusion: Laparoscopic Nissen fundoplication is a feasible and effective procedure, with minimal morbidity, including in infancy.

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Variations in preoperative decision making for antireflux procedures in pediatric gastroesophageal reflux disease: a survey of pediatric surgeons

Cited by 23 publications

References 15 publications

Nissen fundoplication and combined procedures to reduce recurrence of gastroesophageal reflux disease in neurologically impaired children

Nissen fundoplication and combined procedures to reduce recurrence of gastroesophageal reflux disease in neurologically impaired children

Antireflux Procedures for Gastroesophageal Reflux Disease in Children

Cirurgia Laparoscópica do Refluxo Gastroesofágico na Criança

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