Nissen fundoplication in paediatric patients: 5-year retrospective review of one centre's experience

Abstract

Purpose: While Nissen fundoplication has been reported to be beneficial for paediatric patients with gastroesophageal reflux disease, the significant proportion of neurologically impaired patients who have persistent symptoms or develop complications after surgery remains a cause for concern. This study retrospectively reviews our centre's experience with Nissen fundoplication in infants and children over the past 5 years. Patients: 32 paediatric patients (28 neurologically impaired, four neurologically normal) underwent Nissen fundoplication under one surgeon between 2000 and 2005. Aspiration pneumonia (21), recurrent vomiting (21) and failure to thrive (17) were the main indications for operation. Results: 19 (59.4%) children had full relief of symptoms after surgery. Gastrointestinal symptoms improved in 17 and weight increased in 23, but respiratory complications remained a problem in 12 neurologically impaired patients. Recurrent reflux was documented in four patients: Three (9.4%) had recurrent hiatal hernia and underwent repeat fundoplication. Minor gastrostomy-related problems made up the majority of post-operative complications. Conclusion: Nissen fundoplication is effective for relief of gastrointestinal symptoms, and has a positive impact on post-operative weight gain. However, surgery alone may not be sufficient for resolution and prevention of respiratory complications in neurologically impaired children. Gastrostomy maintenance may additionally prove difficult in a subset of patients; adequate support should be provided to prevent the development of serious complications.