Nissen fundoplication and Boix-Ochoa antireflux procedure: Comparison between two surgical techniques in the treatment of gastroesophageal reflux in children

Over a period of 19 years an antireflux procedure was performed for gastroe sophageal reflux in 59 children. Thirty-two patients underwent Nissen fundo plication and 27 children underwent the Boix-Ochoa antireflux procedure. Si x patients died between two and 15 months post surgery of unrelated causes. Follow-up period from six months to 18 years was available in 45 (85 %) of the surviving patients. This report summarizes the complications and long-term results with the two surgical procedures and their comparisons. The follow-up evaluation includ ed parental interview and physical examination. Upper GI series and pH moni toring were performed only in children with signs and symptoms of recurrent GER or other post-operative complications. At follow-up with a mean period of 8.7 years following Nissen fundoplication, 87.5 % showed good results w ithout any residual symptoms. However, the overall complication rate was as high as 50 %. Following the Boix-Ochoa antireflux procedure, 17 (81 %) chi ldren showed excellent results while four children had recurrent GER. This occurred in two neurologically impaired children and two patients following esophageal atresia repair. No other post-operative complications were enco untered with the Boix-Ochoa antireflux procedure. In our experience, the Boix-Ochoa antireflux procedure should be the proced ure of choice in the surgical treatment of GER in otherwise normal children while the Nissen fundoplication is preferable in neurologically impaired c hildren and in patients with GER following esophageal atresia repair.