IS A GASTRIC DRAINAGE PROCEDURE NECESSARY AT THE TIME OF ANTIREFLUX SURGERY

Background: Gastroesophageal reflux is part of a generalized foregut m otility disorder, which may also include delayed gastric emptying. Wit h persistence of gastroesophageal reflux, or the presence of complicat ions, including recurrent aspiration syndrome and esophageal stricture formation, surgical correction may be indicated. It is uncertain whet her a procedure to resolve delayed gastric emptying is indicated at th is time as well. Methods: Sixty-seven children with proven gastroesoph ageal reflux had preoperative gastric emptying assessed using 99Techne tium-Sn-colloid labelled milk. Delayed gastric emptying was defined as a gastric residual activity of more than 40% at 2 hours after feeding . The antireflux operation was a partial anterior fundoplication. Post operative mirk scans assessed the effect of surgery on gastric emptyin g. Results: Gastric emptying at 2 hours improved overall from a median of 22% before surgery to 17% after surgery. In 17 patients delayed ga stric emptying was identified before surgery; in 15 of those it return ed to within normal limits after surgery. In 50 children with normal g astric emptying before surgery (gastric residual activity at 2 hours 1 6%), 14 (28%) showed delayed gastric emptying in the postoperative sca n. Conclusions: Delayed gastric emptying is common in children who und ergo surgery for gastroesophageal reflux disease. A partial anterior f undoplication antireflux operation improves gastric emptying to within normal limits in the majority (88%) in this group, rendering a synchr onous gastric drainage procedure unnecessary. (C) 1997 Lippincott-Rave n Publishers.