Effectiveness of fundoplication in early infancy

Purpose: The aim of this study was to evaluate the results of fundoplicatio n performed in the first 4 months of life. Methods: Case-notes of 66 patients less than 4 months old who underwent fun doplication between January 1986 and July 1997 were reviewed. The mean leng th of follow-up was 24 months (range, 3 to 115 months). Diagnosis of gastro oesophageal reflux (GOR) was based on a barium meal in 55 patients or 24-ho ur pH monitoring in 23 patients. Results: Fundoplication was performed at a median age of 9 weeks (range, 3 to 15 weeks). Associated anomalies were identified in 56 infants and includ ed oesophageal atresia or tracheooesophageal fistula (n = 19), lung abnorma lities (n = 7), congenital diaphragmatic hernia (n = 4), and Various other complex syndromes including neurological disorders (n = 26). Isolated GOR o ccurred in 10. Ninety percent of infants with isolated GOR improved clinica lly after the fundoplication compared with 64% of those with associated eno malies. Only 58% of infants in whom GOR developed after oesophageal atresia repair improved after fundoplication. Vomiting was reduced after fundoplic ation in 76% of infants, apnoea and/or respiratory symptoms improved in 66% , whereas failure to thrive incidence improved in only 38% of infants. Revi sion of the fundoplication was required in 16 (24%) patients. There were ei ght deaths, all of which occurred at least 6 months after the fundoplicatio n. Conclusions: Fundoplication in early infancy is unsuccessful in a high prop ortion of patients. The highest incidence of failure and redo fundoplicatio n occurred in infants with associated anomalies. The best results were achi eved in infants with emesis and respiratory symptoms.