Journal of Paediatrics and Neonatal Disorders
Volume 1 | Issue 1
Outcomes after Pediatric Fundoplication: Defining the Redo Population
Baerg JE*1, Perrone EE1, Vannix RA1, Thorpe DL1, Gasior A2 and St Peter SD2
¹Loma Linda University and Children’s Hospital Loma Linda, CA, USA
²Children’s Mercy Hospital, Kansas City, MO, USA
*Corresponding author: Baerg JE, MD, Associate Professor, Pediatric Surgery, Rm. 21111, Coleman Pavilion, 11175 Campus St., Loma Linda, CA 92354, Fax: 909 558 7978, Tel: 909 558 4619, E-mail: firstname.lastname@example.org
Citation: Baerg JE, Perrone EE, Vannix RA, Thorpe DL, Gasior A, et al. (2015) Outcomes after Pediatric Fundoplication: Defining the Redo Population. J Paedatr Neonatal Dis 1(1): 102
Objective: The aims were to compare outcome variables in children with gastroesophageal reflux disease (GERD) and one Nissen fundoplication to children with redo fundoplications and define the pediatric redo population.
Methods: After IRB approval (#5100277), a case control study was conducted of children younger than 18 years, from two children’s hospitals, with one Nissen fundoplication (control group) or a redo performed between January 1995 and March 2011. Complete data were collected by phone calls to caregivers in December 2012. Only redo operations performed after recurrence of GERD symptoms and wrap herniation into the mediastinum confirmed by contrast radiograph were included. To define the redo population, variables present before initial fundoplication, and outcome variables identified in December 2012, were compared. Continuous variables were analyzed by t-tests and categorical variables by chi-square tests. Logistic regression evaluated variable independence.
Results: The families of 212 children were contacted (54% male), 181 had one fundoplication (85.4%) and 31 had redos (14.6%). The median follow-up time for controls was 3.6 years (range: 0.9-16 years). The median time to first redo was 17 months (range: 1-108 months) and to second redo for 3/31 (9.7%), it was 32.5 months (range: 23-69 months). A significantly greater number with redos, could not feed orally prior to undergoing their first Nissen fundoplication (p=0.003). At follow-up evaluation, children with redos had significantly more hospital admissions for pneumonia (p=0.02), vomiting and retching (p=0.01), gastrojejunal feeding tubes (p=0.01) and wrap herniation on contrast radiograph (p=0.01). Logistic regression revealed vomiting, OR: 3.4 (95% CI: 1.4-8.3) and retching, OR: 3.8 (95% CI: 1.6-9.2) were independently associated with the redo population.
Conclusion: At follow-up evaluation, vomiting and retching are independent factors that define the redo population. Significantly more children with redos are fed by gastrojejunal feeding tubes because the redo fails to control their GERD symptoms.
Keywords: Redo Nissen fundoplication; Pediatric gastroesophageal reflux disease
List of abbreviations: GERD: Gastroesophageal reflux disease; ALTE: Acute life threatening event; BMI: Body mas
Children with complications of gastroesophageal reflux disease (GERD) frequently undergo Nissen fundoplication. There is significant heterogeneity among pediatric GERD studies . Surgical treatment for GERD is reported to improve quality of life, especially for neurologically impaired children [2,3]. Despite initial symptomatic relief, however, the incidence of redo operation after fundoplication is reported between 1.7 and 18 percent [3-6]. Little is known about the outcome for children with GERD that require a redo fundoplication. The aims of this study were to compare outcome variables in children with one Nissen fundoplication for gastroesophageal reflux disease (GERD) to those with redo operations, define the pediatric redo population and make clinical recommendations.