Reoperation after Nissen fundoplication in children with gastroesophageal reflux: experience with 130 patients

• Published in: Annals of surgery 1997-09, Vol.226 (3), p.315-323
• Main Authors: Dalla Vecchia, L K, Grosfeld, J L, West, K W, Rescorla, F J, Scherer, 3rd, L R, Engum, S A
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Endoscopy, Digestive System; Esophagitis - complications; Esophagitis - diagnosis; Female; Fundoplication - adverse effects; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - surgery; Humans; Infant; Male; Recurrence; Reoperation; Retrospective Studies
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199709000-00011

The authors evaluate reoperation for recurrent gastroesophageal reflux (GER) after a failed Nissen fundoplication. Nissen fundoplication is an accepted treatment for GER refractory to medical therapy. Wrap failure and recurrence of GER are noted in 8% to 12%. Medical records of 130 children undergoing a second antireflux operation for recurrent GER from January 1985 to June 1996 retrospectively were reviewed. 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 (