THE EFFECT OF GASTROESOPHAGEAL REFLUX ON LARYNGOTRACHEAL RECONSTRUCTION

Objectives: To determine the need for preoperative evaluation for gast roesophageal reflux disease (GERD) in all children undergoing laryngot racheal reconstruction (LTR) and to assess the effect of GERD on the o utcome of LTR. Design: Prospective, single-blind, observational study. Setting: Tertiary care children's hospital. Patients: Seventy-four pe diatric patients with laryngotracheal stenosis who underwent LTR at th e Children's National Medical Center, Washington, DC, from October 1, 1986, through August 31, 1994. Intervention: Evaluation for and treatm ent of GERD, LTR, endoscopy, and removal of granulation tissue. Main O utcome Measures: Successful decannulation and number of endoscopies re quired to remove laryngeal and tracheal granulation tissue. Results: S eventy-four patients underwent 82 LTRs. The senior surgeon was blinded to the status of GERD evaluation and treatment. Four groups were iden tified: 37 patients (40 LTRs) with no preoperative evaluation for GERD ; 10 patients (11 LTRs) with normal findings on preoperative evaluatio n for GERD; seven patients (nine LTRs) with abnormal findings on preop erative evaluation for GERD but who failed to receive appropriate trea tment; and 20 patients (22 LTRs) with abnormal findings on preoperativ e evaluation for GERD who received appropriate therapy. Severity and e xtent of stenosis as determined by multicentricity of stenosis, type o f repair, and duration of stent were similar in the four groups. The e ffect of GERD and its treatment on the outcome of LTR was measured by the number of endoscopies necessary for removal of granulation tissue following reconstruction and successful decannulation. Statistical ana lyses indicate that (1) all children do not require preoperative evalu ation for GERD; (2) neither the presence of GERD nor its treatment are major factors in determining the outcome of LTR. Conclusion: Preopera tive evaluation for GERD and its treatment do not favorably affect the outcome of LTR.