TRENDS IN THE USE OF FUNDOPLICATION IN CHILDREN WITH GASTROESOPHAGEALREFLUX

Objective: To document changing trends in the indications for fundopli cation in children with gastro-oesophageal reflux and to identify the main shortcomings and complications of the procedure. Methodology: Ret rospective review of 405 consecutive children undergoing fundoplicatio n between 1978 and 1992 inclusive. Results: Trends in the indications for fundoplication related to broadening of its use in those with seve re neurological impairment and uncontrolled reflux, and to changes in the management of patients in the neonatal period. Complications inclu ded unwrapping with recurrence of reflux, hiatal hernia, adhesive smal l bowel obstruction, dumping syndrome, postoperative persistence of oe sophageal stricture, excessively tight wrap and poor oesophageal clear ance (mostly in oesophageal atresia patients). Conclusions: This study identified those patients most likely to develop complications follow ing fundoplication. This may assist in the pre-operative assessment of the likely benefit of fundoplication in children who often have other complex problems.