OUTCOME OF NISSEN FUNDOPLICATION USING INTRAOPERATIVE MANOMETRY IN CHILDREN

Background: Intraoperative manometry is useful in performing Nissen fu ndoplication (NF) in children. Long-term clinical outcome information after use of this method is lacking. Methods: A retrospective review o f the outcomes of 62 consecutive NFs using intraoperative manometry wa s performed. The follow-up period was 3.4 years. Approximately half of the patients were neurologically normal (NN) and half were neurologic ally impaired (NI). All patients with gastroesophageal reflux disease (GERD) did not respond to an adequate trial of medical treatment. Resu lts: The NF was tailored to result in a twofold increase in the lower esophageal sphincter pressure (LESP) and a 75% increase in the LES len gth (LESL). An accelerated growth rate in 40% of ''failure to thrive'' (FTT) patients was demonstrated. Eighty-four percent of caregivers re ported improved quality of life after NF. There was a twofold reductio n in the number of hospital admissions and a sixfold reduction in tota l inpatient days for both NI and NN children. The early and late morta lity rate was 13%, and the complication rate was similar to other seri es reported in the literature, with more complications occurring in NI patients. There was a 2% incidence of wrap herniation. An improvement in long-term outcomes after NF was seen in 89% of NN children and ove r half of NI patients. Conclusions: Intraoperative manometry is useful in standardizing the tightness of the wrap in NF. There was a low inc idence of complications, dysphagia, recurrent emesis, and GERD in this series. Long-term outcomes using this technique were deemed very good based on caregivers' responses. Copyright (C) 1998 by W.B. Saunders C ompany.