title: Simultaneous correction of malrotation and gastroesophageal reflux in infants.
abstract: Gastroesophageal reflux (GER) is often associated with gastrointestinal malrotation in infants. Primary correction of the malrotation, reserving a secondary antireflux procedure for those patients with persistent symptoms of GER, is most commonly practiced. This decision is based on the notion that an antireflux procedure may be unnecessary and is associated with added morbidity. We retrospectively reviewed 12 infants with GER and malrotation. All infants had symptoms attributed to GER and/or malrotation. A control group of seven infants with malrotation only was included for comparison of operative duration and postoperative recovery. Infants who received concurrent Ladd and Nissen procedures (Group 1, n=8) had immediate resolution of symptoms. Infants treated by Ladd procedure alone (Group 2, n=4), had persistent symptoms, despite postoperative medical therapy. A subsequent antireflux procedure was necessary. Comparison of operative times showed that a simultaneous procedure added, on average, 35 minutes to the Ladd procedure. Postoperative feeding and hospital stay were comparable between Group 1 and the control group. In contrast, Group 2 patients had longer hospitalizations due to ineffective medical therapy for persistent GER. No significant morbidity was noted. We recommend comprehensive surgical treatment with concurrent Ladd and Nissen procedures. This approach provides expedient and effective treatment of GER and malrotation, with minimal increase in operative time and no increase in morbidity .
authors.affiliation: Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
authors.forename: C
authors.initials: C
authors.lastname: Chung
authors.forename: N
authors.initials: N
authors.lastname: Bautista
authors.forename: V
authors.initials: V
authors.lastname: Rowe
authors.forename: M
authors.initials: M
authors.lastname: Krishnamoorthy
authors.forename: H
authors.initials: H
authors.lastname: Applebaum
mesh_terms: D004065:Digestive System Abnormalities; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies