EFFICACY OF PARTIAL WRAP FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX AFTER REPAIR OF ESOPHAGEAL ATRESIA

Gastroesophageal reflux (GER) often develops in children who have unde rgone prior repair of esophageal atresia/tracheoesophageal fistula (EA /TEF). Fundoplication is necessary in many of these children, The comp lete wrap (Nissen) fundoplication is often used in this setting. Howev er, poor results have been noted, with a mean failure rate of 30% repo rted in four recent studies. A partial wrap fundoplication for GER ass ociated with EA/TEF is theoretically attractive, because the poor esop hageal motility and diminished acid clearance (already physiologically present) is exacerbated by a complete wrap fundoplication. The author s reviewed their extensive experience with partial wrap (That) fundopl ication in EA/TEF to determine if the failure rate was better than tha t reported for the Nissen fundoplication. In the past 18 years, the au thors performed 1,467 fundoplication procedures. During the same perio d, 143 children underwent repair of EA/TEF. Fifty-nine children underw ent fundoplication after a previous EA/TEF repair. Most of the fundopl ications (58 of 59, 98%) were Thal procedures. Defining failure strict ly as a need for reoperation, the failure rate in our series was 15% ( 9 of 59 children). Compared with the failure rate in the 1,408 non-EA/ TEF patients (61 of 1408, 4.3%), results were significantly worse for the EA/TEF group (P >.001). The failure rate of Thal fundoplication pe rformed for GER in the EA/TEF population is substantially higher than the non-EA/TEF patients. The same factors responsible for the developm ent of reflux in these children (poor acid clearance, altered motility , esophageal shortening) may contribute to the higher failure rate. Al though partial wrap fundoplication frequently failed (15%), the result s were still substantially better than those reported for Nissen fundo plication in these children (30% failure rate). Copyright (C) 1997 by W.B. Saunders Company.