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Characterization and management of paraesophageal hernias in children after antireflux operation
Purpose: The aim of this study was to determine the important factors in the development and subsequent treatment of postoperative paraesophageal hernia (PPEH). Methods: A retrospective analysis was performed in 464 consecutive children (ages 3 days to 18 years) for PPEH after a primary antireflux o...
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| Published in: | Journal of pediatric surgery 1999-11, Vol.34 (11), p.1610-1614 |
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| container_title | Journal of pediatric surgery |
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| creator | Avansino, Jeffrey R Lorenz, Mary L Hendrickson, Margo Jolley, Stephen G |
| description | Purpose:
The aim of this study was to determine the important factors in the development and subsequent treatment of postoperative paraesophageal hernia (PPEH).
Methods:
A retrospective analysis was performed in 464 consecutive children (ages 3 days to 18 years) for PPEH after a primary antireflux operation performed at a Children's Hospital and University Hospital between 1985 and 1997. All operations included a crural repair, but the Nissen fundoplication was performed with (n = 162) and without (n = 70) plication of the esophagus to the crus at 3 points. Patients with and without PPEH were compared with respect to the type of antireflux operation, the patient's age at operation, and the preoperative and postoperative clinical courses. A preoperative corrected gastric emptying value was obtained from a radionuclide gastric emptying study in 289 patients. The treatment of PPEH also was examined.
Results:
The incidence of PPEH in our patients was 4.5% (21 of 464). Although there was a lower incidence of PPEH in patients with crural plication compared with patients without crural plication during Nissen fundoplication (5 of 162, 3%
v 7 of 70, 10%;
P = .035), 2 patients with crural plication had a postoperative esophageal leak. Patients with PPEH had a significantly increased prevalence of gagging before the initial antireflux operation compared with patients without PPEH (3 of 21, 14.3%
v 7 of 443, 1.6%;
P = .007). A higher prevalence of slow corrected gastric emptying preoperatively also was seen in patients with PPEH compared with patients without PPEH (8 of 15, 53%
v 79 of 274, 29%;
P = .046). The prevalences of central nervous system disease, young age ( |
| doi_str_mv | 10.1016/S0022-3468(99)90627-9 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69343037</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022346899906279</els_id><sourcerecordid>69343037</sourcerecordid><originalsourceid>FETCH-LOGICAL-c390t-dc6b70bbf3d264f946f945b4a61cfe4475985f7be0b97d0c3217965d4e9b71083</originalsourceid><addsrcrecordid>eNqFkMFO3DAURS1EBVPgE6iyQKhdBJ7j2BmvEBoBrYTEAlgbx37uGCVOsDNV6ddjZka0uy4sS0_nXj8fQo4pnFGg4vweoKpKVov5Vym_SRBVU8odMqOc0ZIDa3bJ7APZJ59TegbIY6B7ZJ8Cl5RzNiNPi6WO2kwY_R89-SEUOtii10H_xB7DVAyuGDOBaRiXeaa7YokxeJ0KHwqz9J2NmEMuN-To5CO6bvW7GEaM675D8snpLuHR9j4gj9dXD4vv5e3dzY_F5W1pmISptEa0DbStY7YStZO1yIe3tRbUOKzrhss5d02L0MrGgmEVbaTgtkbZNhTm7ICcbnrHOLysME2q98lg1-mAwyopIVnN8v8zyDegiUNKeV01Rt_r-KooqHe1aq1WvXtTUqq1WiVz7sv2gVXbo_0ntXGZgZMtoJPRnYs6GJ_-chVngkLGLjYYZhu_PEaVjMdg0GZ3ZlJ28P_Z5A0BuJbM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69343037</pqid></control><display><type>article</type><title>Characterization and management of paraesophageal hernias in children after antireflux operation</title><source>Elsevier</source><creator>Avansino, Jeffrey R ; Lorenz, Mary L ; Hendrickson, Margo ; Jolley, Stephen G</creator><creatorcontrib>Avansino, Jeffrey R ; Lorenz, Mary L ; Hendrickson, Margo ; Jolley, Stephen G</creatorcontrib><description>Purpose:
The aim of this study was to determine the important factors in the development and subsequent treatment of postoperative paraesophageal hernia (PPEH).
Methods:
A retrospective analysis was performed in 464 consecutive children (ages 3 days to 18 years) for PPEH after a primary antireflux operation performed at a Children's Hospital and University Hospital between 1985 and 1997. All operations included a crural repair, but the Nissen fundoplication was performed with (n = 162) and without (n = 70) plication of the esophagus to the crus at 3 points. Patients with and without PPEH were compared with respect to the type of antireflux operation, the patient's age at operation, and the preoperative and postoperative clinical courses. A preoperative corrected gastric emptying value was obtained from a radionuclide gastric emptying study in 289 patients. The treatment of PPEH also was examined.
Results:
The incidence of PPEH in our patients was 4.5% (21 of 464). Although there was a lower incidence of PPEH in patients with crural plication compared with patients without crural plication during Nissen fundoplication (5 of 162, 3%
v 7 of 70, 10%;
P = .035), 2 patients with crural plication had a postoperative esophageal leak. Patients with PPEH had a significantly increased prevalence of gagging before the initial antireflux operation compared with patients without PPEH (3 of 21, 14.3%
v 7 of 443, 1.6%;
P = .007). A higher prevalence of slow corrected gastric emptying preoperatively also was seen in patients with PPEH compared with patients without PPEH (8 of 15, 53%
v 79 of 274, 29%;
P = .046). The prevalences of central nervous system disease, young age (<6 months) at initial operation, and a particular type of antireflux operation were not higher in patients with PPEH. Nine patients with a small PPEH treated by simple observation alone subsequently had resolution of symptoms.
Conclusions:
Patients who have gagging or slow corrected gastric emptying before an antireflux operation are at higher risk for a postoperative paraesophageal hernia. Patients with a small postoperative paraesophageal hernia can be treated nonoperatively. Crural plication of the esophagus during Nissen fundoplication reduces the occurrence of postoperative paraesophageal hernia, but also may result in significant morbidity.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/S0022-3468(99)90627-9</identifier><identifier>PMID: 10591553</identifier><identifier>CODEN: JPDSA3</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Adolescent ; Biological and medical sciences ; Child ; Child, Preschool ; Digestive System Surgical Procedures - methods ; Esophagus ; Female ; Follow-Up Studies ; Fundoplication - adverse effects ; Fundoplication - methods ; Gastric Emptying - physiology ; Gastroenterology. Liver. Pancreas. Abdomen ; Gastroesophageal Reflux - surgery ; Hernia, Hiatal - epidemiology ; Hernia, Hiatal - etiology ; Hernia, Hiatal - surgery ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Medical sciences ; Other diseases. Semiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome</subject><ispartof>Journal of pediatric surgery, 1999-11, Vol.34 (11), p.1610-1614</ispartof><rights>1999</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-dc6b70bbf3d264f946f945b4a61cfe4475985f7be0b97d0c3217965d4e9b71083</citedby><cites>FETCH-LOGICAL-c390t-dc6b70bbf3d264f946f945b4a61cfe4475985f7be0b97d0c3217965d4e9b71083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,780,784,789,790,23930,23931,25140,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1253610$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10591553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Avansino, Jeffrey R</creatorcontrib><creatorcontrib>Lorenz, Mary L</creatorcontrib><creatorcontrib>Hendrickson, Margo</creatorcontrib><creatorcontrib>Jolley, Stephen G</creatorcontrib><title>Characterization and management of paraesophageal hernias in children after antireflux operation</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Purpose:
The aim of this study was to determine the important factors in the development and subsequent treatment of postoperative paraesophageal hernia (PPEH).
Methods:
A retrospective analysis was performed in 464 consecutive children (ages 3 days to 18 years) for PPEH after a primary antireflux operation performed at a Children's Hospital and University Hospital between 1985 and 1997. All operations included a crural repair, but the Nissen fundoplication was performed with (n = 162) and without (n = 70) plication of the esophagus to the crus at 3 points. Patients with and without PPEH were compared with respect to the type of antireflux operation, the patient's age at operation, and the preoperative and postoperative clinical courses. A preoperative corrected gastric emptying value was obtained from a radionuclide gastric emptying study in 289 patients. The treatment of PPEH also was examined.
Results:
The incidence of PPEH in our patients was 4.5% (21 of 464). Although there was a lower incidence of PPEH in patients with crural plication compared with patients without crural plication during Nissen fundoplication (5 of 162, 3%
v 7 of 70, 10%;
P = .035), 2 patients with crural plication had a postoperative esophageal leak. Patients with PPEH had a significantly increased prevalence of gagging before the initial antireflux operation compared with patients without PPEH (3 of 21, 14.3%
v 7 of 443, 1.6%;
P = .007). A higher prevalence of slow corrected gastric emptying preoperatively also was seen in patients with PPEH compared with patients without PPEH (8 of 15, 53%
v 79 of 274, 29%;
P = .046). The prevalences of central nervous system disease, young age (<6 months) at initial operation, and a particular type of antireflux operation were not higher in patients with PPEH. Nine patients with a small PPEH treated by simple observation alone subsequently had resolution of symptoms.
Conclusions:
Patients who have gagging or slow corrected gastric emptying before an antireflux operation are at higher risk for a postoperative paraesophageal hernia. Patients with a small postoperative paraesophageal hernia can be treated nonoperatively. Crural plication of the esophagus during Nissen fundoplication reduces the occurrence of postoperative paraesophageal hernia, but also may result in significant morbidity.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>Esophagus</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fundoplication - adverse effects</subject><subject>Fundoplication - methods</subject><subject>Gastric Emptying - physiology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Hernia, Hiatal - epidemiology</subject><subject>Hernia, Hiatal - etiology</subject><subject>Hernia, Hiatal - surgery</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Other diseases. Semiology</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><recordid>eNqFkMFO3DAURS1EBVPgE6iyQKhdBJ7j2BmvEBoBrYTEAlgbx37uGCVOsDNV6ddjZka0uy4sS0_nXj8fQo4pnFGg4vweoKpKVov5Vym_SRBVU8odMqOc0ZIDa3bJ7APZJ59TegbIY6B7ZJ8Cl5RzNiNPi6WO2kwY_R89-SEUOtii10H_xB7DVAyuGDOBaRiXeaa7YokxeJ0KHwqz9J2NmEMuN-To5CO6bvW7GEaM675D8snpLuHR9j4gj9dXD4vv5e3dzY_F5W1pmISptEa0DbStY7YStZO1yIe3tRbUOKzrhss5d02L0MrGgmEVbaTgtkbZNhTm7ICcbnrHOLysME2q98lg1-mAwyopIVnN8v8zyDegiUNKeV01Rt_r-KooqHe1aq1WvXtTUqq1WiVz7sv2gVXbo_0ntXGZgZMtoJPRnYs6GJ_-chVngkLGLjYYZhu_PEaVjMdg0GZ3ZlJ28P_Z5A0BuJbM</recordid><startdate>19991101</startdate><enddate>19991101</enddate><creator>Avansino, Jeffrey R</creator><creator>Lorenz, Mary L</creator><creator>Hendrickson, Margo</creator><creator>Jolley, Stephen G</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19991101</creationdate><title>Characterization and management of paraesophageal hernias in children after antireflux operation</title><author>Avansino, Jeffrey R ; Lorenz, Mary L ; Hendrickson, Margo ; Jolley, Stephen G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-dc6b70bbf3d264f946f945b4a61cfe4475985f7be0b97d0c3217965d4e9b71083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>Esophagus</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fundoplication - adverse effects</topic><topic>Fundoplication - methods</topic><topic>Gastric Emptying - physiology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Hernia, Hiatal - epidemiology</topic><topic>Hernia, Hiatal - etiology</topic><topic>Hernia, Hiatal - surgery</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Other diseases. Semiology</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Avansino, Jeffrey R</creatorcontrib><creatorcontrib>Lorenz, Mary L</creatorcontrib><creatorcontrib>Hendrickson, Margo</creatorcontrib><creatorcontrib>Jolley, Stephen G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Avansino, Jeffrey R</au><au>Lorenz, Mary L</au><au>Hendrickson, Margo</au><au>Jolley, Stephen G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characterization and management of paraesophageal hernias in children after antireflux operation</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>1999-11-01</date><risdate>1999</risdate><volume>34</volume><issue>11</issue><spage>1610</spage><epage>1614</epage><pages>1610-1614</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><coden>JPDSA3</coden><abstract>Purpose:
The aim of this study was to determine the important factors in the development and subsequent treatment of postoperative paraesophageal hernia (PPEH).
Methods:
A retrospective analysis was performed in 464 consecutive children (ages 3 days to 18 years) for PPEH after a primary antireflux operation performed at a Children's Hospital and University Hospital between 1985 and 1997. All operations included a crural repair, but the Nissen fundoplication was performed with (n = 162) and without (n = 70) plication of the esophagus to the crus at 3 points. Patients with and without PPEH were compared with respect to the type of antireflux operation, the patient's age at operation, and the preoperative and postoperative clinical courses. A preoperative corrected gastric emptying value was obtained from a radionuclide gastric emptying study in 289 patients. The treatment of PPEH also was examined.
Results:
The incidence of PPEH in our patients was 4.5% (21 of 464). Although there was a lower incidence of PPEH in patients with crural plication compared with patients without crural plication during Nissen fundoplication (5 of 162, 3%
v 7 of 70, 10%;
P = .035), 2 patients with crural plication had a postoperative esophageal leak. Patients with PPEH had a significantly increased prevalence of gagging before the initial antireflux operation compared with patients without PPEH (3 of 21, 14.3%
v 7 of 443, 1.6%;
P = .007). A higher prevalence of slow corrected gastric emptying preoperatively also was seen in patients with PPEH compared with patients without PPEH (8 of 15, 53%
v 79 of 274, 29%;
P = .046). The prevalences of central nervous system disease, young age (<6 months) at initial operation, and a particular type of antireflux operation were not higher in patients with PPEH. Nine patients with a small PPEH treated by simple observation alone subsequently had resolution of symptoms.
Conclusions:
Patients who have gagging or slow corrected gastric emptying before an antireflux operation are at higher risk for a postoperative paraesophageal hernia. Patients with a small postoperative paraesophageal hernia can be treated nonoperatively. Crural plication of the esophagus during Nissen fundoplication reduces the occurrence of postoperative paraesophageal hernia, but also may result in significant morbidity.</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>10591553</pmid><doi>10.1016/S0022-3468(99)90627-9</doi><tpages>5</tpages></addata></record> |
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| source | Elsevier |
| subjects | Adolescent Biological and medical sciences Child Child, Preschool Digestive System Surgical Procedures - methods Esophagus Female Follow-Up Studies Fundoplication - adverse effects Fundoplication - methods Gastric Emptying - physiology Gastroenterology. Liver. Pancreas. Abdomen Gastroesophageal Reflux - surgery Hernia, Hiatal - epidemiology Hernia, Hiatal - etiology Hernia, Hiatal - surgery Humans Incidence Infant Infant, Newborn Male Medical sciences Other diseases. Semiology Prognosis Retrospective Studies Risk Factors Treatment Outcome |
| title | Characterization and management of paraesophageal hernias in children after antireflux operation |
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