Surgical Management of Gastroesophageal Reflux Disease

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=Abstract=

Surgical Management of Gastroesophageal Reflux Disease

Seong"Chul Kim, M.D., Dae-Yeon Kim, M.D., Kyung-Mo Kim, M.D.*, In-Koo Kim, M.D.

Division of Pediatric Surgery, Department of PediatriCS*

University of Ulsan College of Medicine and Asan Medical Center Seoul, Korea

Eleven children with gastroesophageal reflux disease underwent fundoplication.

Eight had neurological impairment, two had hiatal hernias and one had a history of esophageal repair for esophageal atresia. The most common and significant symptom was vomiting(81.8 %), followed by recurrent respiratory infections(72.7

%) and failure to thrive(72.7 %). The most common diagnostic tool was 24 hour esophageal pH study, which showed pH less than 4 for more than 10 % of the total recorded time in 6 of 9 patients. Nissen fundoplication was performed in 10 patients. ThaI fundoplication was carried out in one patient with esophageal atresia. Stamm gastrostomy was added for nutritional and/or swallowing problem in all 8 patients with neurological impairment. The median follow up period was 13 months. There was one late death of unrelated cause and one recurrence.

The quality of life after antireflux surgery was greatly improved. Antireflux surgery should be done if indicated, and a simultaneous gastrostomy considered in a patient with neurological impairment.

Index Words: Gastroesopha{;eal reflux, Fundoplication, Gastrostomy

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Correspondence: In-Two Kim, M.D., Division of Pediatric Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea

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Fig. 1. An esophagogram, showing reflux to cervical esophagus and loss of angle of His.

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Fig. 3.

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