The value of 24-h pH study in evaluating the results of laparoscopic antireflux surgery in children.
BACKGROUND
The performance of laparoscopic antireflux surgery is steadily increasing among pediatric surgeons. Different techniques are being used. However, due to a lack of standardized follow-up methods, postoperative results are difficult to compare. In this study, we describe the results of postoperative 24-h pH study as an objective criterion for evaluating the results of laparoscopic Thal antireflux surgery.


METHODS
In a prospective study, 53 patients underwent a laparoscopic Thal procedure. Preoperatively, all patients were subjected to 24-h pH monitoring, an upper GI series, and esophagogastroscopy. pH monitoring was performed 3 months postoperatively to evaluate the effect of the fundoplication. Esophagogastroscopy was repeated in case of preoperative esophagitis.


RESULTS
In one patient, the laparoscopy was converted to an open procedure. Feeding was commenced on day 1 in 49 of the 53 children. Mean hospitalization time was 4.4 days. One patient was reoperated for a too-tight fundoplication, and two patients died of unrelated causes. Ultimately, 44 of 50 children (88%) were free of symptoms; however, 11 of 41 children (25%) still displayed pathological reflux on pH monitoring.


CONCLUSIONS
The Thal fundoplication can be performed laparoscopically in children. Children have a quick recovery, and hospitalization is short (4.4 days). At follow-up, nearly 90% of the children are free of symptoms. However, 25% still have pathological reflux as measured with pH monitoring. Therefore, questionnaires alone are not a sufficient means of measuring outcome postoperative. pH monitoring is a valuable additional tool for the objective postoperative evaluation of the results of (laparoscopic) antireflux procedures.
van der Zee
D C
DC
Department of Pediatric Surgery, Wilhelmina Children's University Hospital, Post Office Box 85090, 3508AB Utrecht, The Netherlands.
Arends
N J
NJ
Bax
N M
NM
D002648:Child; D004947:Esophagus / Q000378:metabolism*; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000378:metabolism / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008991:Monitoring, Physiologic; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence