Nissen fundoplication in the management of gastroesophageal reflux occurring after repair of esophageal atresia

Background/Purpose: Gastroesophageal reflux is a major cause of complicatio ns after esophageal atresia repair. The suitability of the Nissen fundoplic ation in these patients is still disputed. Therefore, the authors evaluated the results of their prospective treatment protocol in those patients who underwent a Nissen fundoplication. Methods: From 1984 to 1996, 125 patients underwent anastomosis for esophage al atresia. A Nissen fundoplication was later performed in 29 patients. The prospective protocol included x-ray after 10 days, 6 weeks, 12 weeks, 6 mo nths, and 12 months. Forty-eight-hour pH measurements were performed betwee n 6 and 12 weeks. Mean postfundoplication follow-up was at least 5 years (r ange, 2 to 13 yea rs). Results: Two of the 29 patients died after the Nissen fundoplication from u nrelated causes. A third patient was excluded from the study group. Ninetee n of the remaining 26 patients showed severe stricture, pH-metry succeeded in 18 patients, showing pathological reflux in 17. In 24 patients the fundo plication was performed between 1 and 24 months (median, 4 months), in the other 2 patients much later. In 4 of the 26 patients(15%) the Nissen proved to be insufficient and had to be redone. The remaining 22 patients had no short-term or long-term complications. Conclusion: The authors' findings in this group of patients, comparing them with the results reported in the literature, indicate that there is no rea son to change their prospective treatment protocol nor their policy to perf orm Nissen fundoplications at an early stage. Copyright (C) 2000 by W.B. Sa unders Company.