COMBINED HOSPITAL EXPERIENCE WITH FUNDOPLICATION AND GASTRIC-EMPTYINGPROCEDURE FOR GASTROESOPHAGEAL REFLUX IN CHILDREN

BACKGROUND: Operative treatment of symptomatic gastroesophageal reflux (GER), often together with neurologic feeding disorders, is very comm on in infancy and childhood, Delayed gastric emptying (DGE) has been o bserved frequently in association with GER in children, STUDY DESIGN: A retrospective review was performed on 1,200 consecutive patients 18 years of age and younger operated upon for symptomatic GER or neurolog ic feeding disorders, or both, at two pediatric surgery centers in wid ely separated geographic areas in the United States of America, to com pare the results after fundoplication with or without a gastric emptyi ng procedure (GEP), RESULTS: Operations included gastroesophageal fund oplication (CEF) alone (871 patients), GEF plus GEP (286 patients), re operative GEF plus GEP (30 patients), and GEP alone (13 patients), Thu s, 27 percent of the total and 40 percent of the last 494 children wit h reflux had a GEP. Delayed gastric emptying with retention of more th an 60 percent of an isotope meal appropriate for age at 90 minutes was present in 241 of the 451 children with reflux studied, Major neurolo gic disorders were present in 219 (25 percent) of 871 children who und erwent GEF alone and in 247 (75 percent) of 329 children who had a GEP . Ah patients operated upon from both hospitals were relieved of recur rent emesis, and those with failure to thrive showed significant weigh t gain; pulmonary symptoms were relieved in 94 percent, Recurrent GER developed in 47 (5.2 percent) of 901 children who had GEF alone, but i n only four (1.2 percent) of 329 patients who had a GEP, CONCLUSIONS: The excellent clinical results with low morbidity in this largest repo rted clinical experience with GEP in childhood suggest that a GER shou ld be combined with CEF for symptomatic children who have both GER and DGE, Minimal investigative studies are necessary for most neurologica lly impaired children who require a feeding gastrostomy.