Gastric emptying procedures decrease the risk of postoperative recurrent reflux in children with delayed gastric emptying

Purpose: Although several centers often perform gastric emptying procedures (GEP) together with fundoplication for gastroesophageal reflux (GER) and d elayed gastric emptying (DGE), the benefit of GEP is controversial. The pre sent study addresses the question of whether adding a GEP in children with preoperatively diagnosed GER and DGE affects the recurrence rate of GER aft er Nissen fundoplication (NF). Methods: A retrospective chart review was performed on all children under t he age of 16 years, operated on for GER from 1980 to 1997, who had a preope rative diagnosis of DGE, and at least 6 months of follow-up. Gastric retent ion of more than 50% of a radiolabeled meal at 90 minutes was considered DG E. Recurrent reflux was defined as reappearance of GER symptoms, confirmed by postoperative esophogram or 24 hours of pH monitoring. Results: Of the 183 patients with DGE, 92 were available for long-term foll ow-up. Of these, 20 had no gastric emptying procedure performed (no-GEP gro up) and 72 had a GEP performed together with an NF (GEP group). Groups were comparable as to age at operation, mean follow-up time, male to female rat io and prevalence of associated anomalies. A higher prevalence of neurologi cal impairment (NI) was present in the GEP group (48.6% v 20.0%). Mean preo perative gastric retention was significantly higher in the GEP group (69.9 +/- 1.3%) than in the no-GEP group (61.4 +/- 2.2%). No complications result ed from the GEP. Recurrent reflux rate was 18.1% in the GEP group (13 of 72 ) versus 35.0% (7 of 20) in the no-GEP group. Actuarial analysis disclosed a marginally significant difference in the rate of recurrent reflux between the groups (P = .057) and estimation of the relative risk showed a 1.94 in crease of recurrent reflux risk in the no-GEP (0.89 < RR < 4.20). Conclusions: Children with DGE, who did not have GEP, had twice the frequen cy of recurrent reflux as those who had a GEP. Preoperative screening for D GE, as well as operative correction of DGE at the time of fundoplication, i s therefore recommended. J Pediatr Surg 34:79-83. Copyright (C) 1999 by W.B . Saunders Company.