OPERATIVE TREATMENT OF GASTROESOPHAGEAL REFLUX IN LOW-BIRTH-WEIGHT INFANTS

Operative correction of symptomatic gastroesophageal reflux (GER) has been used frequently and successfully in both children and larger infa nts for many years. In contrast, surgical repair of GER has been appli ed relatively sparingly in very small infants because of perceived tec hnical and postoperative difficulties. We retrospectively reviewed our experience with Nissen fundoplications performed for symptomatic GER in low birth weight (LEW) infants (less than or equal to 2500 grams th e time of surgery). Twenty-one consecutive cases from 1988 to 1993 wer e evaluated. At the time of surgery, the average age was 9.1 weeks and the average weight was 2100 grams (range, 1220 to 2500 grams). All in fants had failed a trial of medical management. Follow-up from 1 month to 5 years showed no intraoperative complications and resolution of s ymptoms in 91 per cent of our patients. Technical factors found to enh ance the success of the operative repairs included appropriately sized dilators, division of the short gastric vessels, and a loose 360-degr ee wrap. With suitable technique, the surgical management of symptomat ic GER can be performed safely in small infants.