LAPAROSCOPIC FUNDOPLICATION TO ENHANCE PULMONARY-FUNCTION IN CHILDRENWITH SEVERE REACTIVE AIRWAY DISEASE AND GASTROESOPHAGEAL REFLUX DISEASE

Background: The relationship between severe reactive airway disease (R AD) and gastroesophageal reflux disease (GERD) has been noted but the relationship is poorly understood. This study reports our experience w ith laparoscopic fundoplication and it's effect on the pulmonary statu s of children with severe steroid-dependent reactive airway disease. M ethods: Fifty-six patients with severe steroid-dependent RAD and medic ally refractory GERD underwent laparoscopic Nissen fundoplications. Me an age was 7 years and mean weight was 20 kg. All patients had the pro cedure completed successfully laparoscopically with an average operati ve time of 62 min. Average hospital stay was 1.6 days. Results: Forty- eight of 56 patients noted significant improvement in their respirator y symptoms in the first week. Fifty of 56 patients have been weaned of f their oral steroids and four others have had a greater than 50% decr ease in their dose. Sixteen patients had a documented increase in thei r FEV1 in the initial postoperative period (avg. 26%). Conclusion: Pat ients with steroid-dependent RAD and GERD refractory to medical manage ment show improvement in their respiratory status following fundoplica tion and the majority can be weaned off of their oral steroids. Laparo scopic techniques allow this procedure to be performed safely even in this high-risk group of patients.