The effect of gastroesophageal reflux on laryngotracheal reconstruction.
OBJECTIVE
To determine the need for preoperative evaluation for gastroesophageal reflux disease (GERD) in all children undergoing laryngotracheal reconstruction (LTR) and to assess the effect of GERD on the outcome of LTR.


METHODS
Prospective, single-blind observational study.


METHODS
Tertiary care children's hospital.


METHODS
Seventy-four pediatric patients with laryngotracheal stenosis who underwent LTR at the Children's National Medical Center, Washington, DC, from October 1, 1986, through August 31, 1994.


METHODS
Evaluation for and treatment of GERD, LTR, endoscopy, and removal of granulation tissue.


METHODS
Successful decannulation and number of endoscopies required to remove laryngeal and tracheal granulation tissue.


RESULTS
Seventy-four patients underwent 82 LTRs. The senior surgeon was blinded to the status of GERD evaluation and treatment. Four groups were identified: 37 patients (40 LTRs) with no preoperative evaluation for GERD; 10 patients (11 LTRs) with normal findings on preoperative evaluation for GERD; seven patients (nine LTRs) with abnormal findings on preoperative evaluation for GERD but who failed to receive appropriate treatment; and 20 patients (22 LTRs) with abnormal findings on preoperative evaluation for GERD who received appropriate therapy. Severity and extent of stenosis as determined by multicentricity of stenosis, type of repair, and duration of stent were similar in the four groups. The effect of GERD and its treatment on the outcome of LTR was measured by the number of endoscopies necessary for removal of granulation tissue following reconstruction and successful decannulation. Statistical analyses indicate that (1) all children do not require preoperative evaluation for GERD; (2) neither the presence of GERD nor its treatment are major factors in determining the outcome of LTR.


CONCLUSIONS
Preoperative evaluation for GERD and its treatment do not favorably affect the outcome of LTR.
Zalzal
G H
GH
Department of Otolaryngology - Head and Neck Surgery, George Washington University, Washington, DC, USA.
Choi
S S
SS
Patel
K M
KM
D000704:Analysis of Variance; D002648:Child; D004724:Endoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis; D006097:Granulation Tissue / Q000601:surgery; D006801:Humans; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000150:complications / Q000601:surgery*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D016037:Single-Blind Method; D015607:Stents; D014135:Tracheal Stenosis / Q000150:complications / Q000601:surgery*