Gastric antroplasty for the treatment of delayed gastric emptying and gastroesophageal reflux in children.
Operative correction of symptomatic gastroesophageal reflux (GER) was undertaken in 530 children during a 21-year period. Gastroesophageal fundoplication (GEF) alone was performed in 415 children; 83 had simultaneous GEF and pyloroplasty; 13 had pyloroplasty alone; and 19 had GEF with later pyloroplasty. Of the last 355 children with reflux, 110 (31%) had pyloroplasty. Pyloroplasty was performed for persistent symptoms despite medical therapy when more than 60% of the isotope meal was retained in the stomach at 90 minutes. Children with central nervous system disorders and GER often had delayed gastric emptying (DGE). A modified Heineke-Mikulicz pyloroplasty was used for the first 59 children; the last 56 patients had a more simplified antroplasty with a 2.5- to 3.5-cm vertical incision through the antral muscularis down to the duodenum without mucosal incision; the muscularis was reapproximated in a transverse direction with sutures. With a mean follow-up of 5.8 years, only three patients experienced mild transient dumping. None had pyloroplasty leak or clinical evidence of alkaline reflux. Antroplasty is a helpful, simple adjunct to GEF with low morbidity in children with GER and DGE.
Fonkalsrud
E W
EW
Division of Pediatric Surgery, UCLA School of Medicine 90024.
Ament
M E
ME
Vargas
J
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004386:Duodenum / Q000601:surgery; D015154:Esophageal Motility Disorders / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008722:Methods; D011312:Pressure; D011706:Pyloric Antrum / Q000601:surgery*; D012008:Recurrence; D013272:Stomach Diseases / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors