Reoperation after nissen fundoplication in children with gastroesophageal reflux: Experience with 130 patients

Laura K.Dalla Vecchia, Jay L. Grosfeld, Karen W. West, Frederick J. Rescorla, L. R. Scherer, Scott A. Engum

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Objective: The authors evaluate reoperation for recurrent gastroesophageal reflux (GER) after a failed Nissen fundoplication. Summary Background Data: Nissen fundoplication is an accepted treatment for GER refractory to medical therapy. Wrap failure and recurrence of GER are noted in 8% to 12%. Methods: Medical records of 130 children undergoing a second antireflux operation for recurrent GER from January 1985 to June 1996 retrospectively were reviewed. Results: One hundred one patients (78%) were neurologically impaired (NI), 74 (57%) had chronic pulmonary disease, and 8 had esophageal atresia. Recurrent symptoms included vomiting (78%), growth failure (62%), choking-coughing-gagging (38%), and pneumonia (25%). Gastroesophageal reflux was confirmed by barium swallow, gastric scintigraphy, and endoscopy. Operative findings showed wrap breakdown (42%), wrap-hiatal hernia (30%), or both (21%). A second Nissen fundoplication was performed in 128 children. Complications included bowel obstruction (18), wound infection (10), pneumonia (6) and tight wrap (9). There were two postoperative (<30 days) deaths (1.5%). Of 124 patients observed long term, 89 (72%) remain symptom free. Eight were converted to tube feedings. Twenty- seven required a third fundoplication, and 19 (70%) were successful outcome. Two with repetitive wrap failure due to gastric atony underwent gastric resection and esophagojejunostomy. Conclusion Nissen fundoplication was successful in 91% of patients. In 9% with wrap failure, a second Nissen fundoplication was successful in 72%. Reoperation is justified in properly selected patients. Conversion to jejunostomy feedings is suggested for neurologically impaired after two wrap failures and a partial wrap in those with esophageal atresia and severe esophageal dysmotility. Repeated wrap failure due to gastric atony requires gastric resection and esophagojejunostomy.

Original languageEnglish (US)
Pages (from-to)315-323
Number of pages9
JournalAnnals of surgery
Volume226
Issue number3
DOIs
StatePublished - Dec 1 1997

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Fundoplication
Gastroesophageal Reflux
Reoperation
Stomach
Esophageal Atresia
Pneumonia
Gagging
Esophageal Motility Disorders
Jejunostomy
Hiatal Hernia
Enteral Nutrition
Wound Infection
Airway Obstruction
Barium
Deglutition
Radionuclide Imaging
Endoscopy
Lung Diseases
Vomiting
Medical Records

ASJC Scopus subject areas

  • Surgery

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Reoperation after nissen fundoplication in children with gastroesophageal reflux : Experience with 130 patients. / Vecchia, Laura K.Dalla; Grosfeld, Jay L.; West, Karen W.; Rescorla, Frederick J.; Scherer, L. R.; Engum, Scott A.

In: Annals of surgery, Vol. 226, No. 3, 01.12.1997, p. 315-323.

Research output: Contribution to journalArticle

Vecchia, Laura K.Dalla ; Grosfeld, Jay L. ; West, Karen W. ; Rescorla, Frederick J. ; Scherer, L. R. ; Engum, Scott A. / Reoperation after nissen fundoplication in children with gastroesophageal reflux : Experience with 130 patients. In: Annals of surgery. 1997 ; Vol. 226, No. 3. pp. 315-323.
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abstract = "Objective: The authors evaluate reoperation for recurrent gastroesophageal reflux (GER) after a failed Nissen fundoplication. Summary Background Data: Nissen fundoplication is an accepted treatment for GER refractory to medical therapy. Wrap failure and recurrence of GER are noted in 8{\%} to 12{\%}. Methods: Medical records of 130 children undergoing a second antireflux operation for recurrent GER from January 1985 to June 1996 retrospectively were reviewed. Results: One hundred one patients (78{\%}) were neurologically impaired (NI), 74 (57{\%}) had chronic pulmonary disease, and 8 had esophageal atresia. Recurrent symptoms included vomiting (78{\%}), growth failure (62{\%}), choking-coughing-gagging (38{\%}), and pneumonia (25{\%}). Gastroesophageal reflux was confirmed by barium swallow, gastric scintigraphy, and endoscopy. Operative findings showed wrap breakdown (42{\%}), wrap-hiatal hernia (30{\%}), or both (21{\%}). A second Nissen fundoplication was performed in 128 children. Complications included bowel obstruction (18), wound infection (10), pneumonia (6) and tight wrap (9). There were two postoperative (<30 days) deaths (1.5{\%}). Of 124 patients observed long term, 89 (72{\%}) remain symptom free. Eight were converted to tube feedings. Twenty- seven required a third fundoplication, and 19 (70{\%}) were successful outcome. Two with repetitive wrap failure due to gastric atony underwent gastric resection and esophagojejunostomy. Conclusion Nissen fundoplication was successful in 91{\%} of patients. In 9{\%} with wrap failure, a second Nissen fundoplication was successful in 72{\%}. Reoperation is justified in properly selected patients. Conversion to jejunostomy feedings is suggested for neurologically impaired after two wrap failures and a partial wrap in those with esophageal atresia and severe esophageal dysmotility. Repeated wrap failure due to gastric atony requires gastric resection and esophagojejunostomy.",
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AU - Vecchia, Laura K.Dalla

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AU - Rescorla, Frederick J.

AU - Scherer, L. R.

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AB - Objective: The authors evaluate reoperation for recurrent gastroesophageal reflux (GER) after a failed Nissen fundoplication. Summary Background Data: Nissen fundoplication is an accepted treatment for GER refractory to medical therapy. Wrap failure and recurrence of GER are noted in 8% to 12%. Methods: Medical records of 130 children undergoing a second antireflux operation for recurrent GER from January 1985 to June 1996 retrospectively were reviewed. Results: One hundred one patients (78%) were neurologically impaired (NI), 74 (57%) had chronic pulmonary disease, and 8 had esophageal atresia. Recurrent symptoms included vomiting (78%), growth failure (62%), choking-coughing-gagging (38%), and pneumonia (25%). Gastroesophageal reflux was confirmed by barium swallow, gastric scintigraphy, and endoscopy. Operative findings showed wrap breakdown (42%), wrap-hiatal hernia (30%), or both (21%). A second Nissen fundoplication was performed in 128 children. Complications included bowel obstruction (18), wound infection (10), pneumonia (6) and tight wrap (9). There were two postoperative (<30 days) deaths (1.5%). Of 124 patients observed long term, 89 (72%) remain symptom free. Eight were converted to tube feedings. Twenty- seven required a third fundoplication, and 19 (70%) were successful outcome. Two with repetitive wrap failure due to gastric atony underwent gastric resection and esophagojejunostomy. Conclusion Nissen fundoplication was successful in 91% of patients. In 9% with wrap failure, a second Nissen fundoplication was successful in 72%. Reoperation is justified in properly selected patients. Conversion to jejunostomy feedings is suggested for neurologically impaired after two wrap failures and a partial wrap in those with esophageal atresia and severe esophageal dysmotility. Repeated wrap failure due to gastric atony requires gastric resection and esophagojejunostomy.

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