WOFAPS 2025 8th World Congress of Pediatric Surgery

Ahmet Pirim, Gonca Gerçel, Meltem Çağlar, Çiğdem Ulukaya Durakbaşa

Department of Pediatric Surgery, Istanbul Medeniyet University, Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Türkiye

Aim: To evaluate the early, mid-term and long-term results of children who underwent surgery for gastroesophageal reflux disease (GERD) and to compare open and laparoscopic surgery.

Method: Records of patients who underwent antireflux surgery between 2011 and 2022 were retrospectively reviewed.

Results: Of the 117 patients, 64 were males (55%). The most common comorbidities were chronic neurological disease (n=78, 67%) and esophageal atresia (n=19, 16%). Fifteen (13%) patients had no comorbidities. 24-hour pH monitoring (73%), GERD scintigraphy (43%), contrast radiography (47%) and/or endoscopy (64%) were used in the diagnosis of GERD. At least two diagnostic tests were performed in 89 (76%) patients. Twenty-six (22%) patients had hiatal hernia. Laparoscopic fundoplication was performed in 89 (76%) patients (Nissen, n=54 and Nissen-Rosetti, n=35) and open fundoplication was performed in 31 (24%). Simultaneous gastrostomy was performed in 62 patients (53%) and pyloroplasty in 12 (10%). Those who underwent laparoscopic surgery reached an earlier full enteral feeding (2.4±1.5 vs 5.3±7.5 days) and discharge (8.5±13 vs 13±11 days). Minor or major complications occurred in 31 (26%) patients and mortality in five patients (4%) in the first 30 days. Late complications were observed in 7 patients (6%), 3 of whom (2.5%) underwent redo fundoplication. Patients who underwent laparoscopic surgery experienced fewer total complications (38% vs 19%) (p<0.005). Antireflux surgery reduced the rates of antireflux medication use (51% vs 19%) and recurrent lung infections (62% vs 31%) (p<0.05). There was a trend towards proportional improvement in preoperative and postoperative evaluation with endoscopic Tytgat (n=47) and Knuff & Leape (n=25) classifications (p>0.05). Mean follow-up was 3.5±2.6 (0.08-11.8) years. Long-term survival rate was 74.3%.

Conclusions: Unlike adults, children requiring antireflux surgery have a high rate of accompanying comorbidities and, as seen in our study, morbidity and mortality are high compared to other patient groups in pediatric surgery. Although questioned in some studies, the surgery performed on the patients in our study provided improvement in medication use and frequent hospitalizations. In children evaluated for GERD and especially for tube feeding, an objective evaluation and selectivity for the indication for antireflux surgery indication is important. Also, the success of the surgery should be evaluated in a standard manner.