Outcome of laparoscopic Nissen-Rossetti fundoplication in children with gastroesophageal reflux disease and supraesophageal symptoms.
BACKGROUND
The role of surgery is debated for children with gastroesophageal reflux disease (GERD), particularly when they show atypical symptoms. This study was designed to evaluate the safety and outcome of laparoscopic Nissen-Rossetti fundoplication performed in a selected population of children with gastroesophageal reflux and atypical supraesophageal symptoms.


METHODS
This prospective study included 595 patients younger than 14 years with GERD who reported recurrent respiratory symptoms and had no benefit from standard medical treatment. Surgery was performed for 48 patients with anatomic anomalies, life-threatening events, or respiratory complications after ineffective medical treatment. The subjective and objective outcomes were evaluated.


RESULTS
No major intraoperative complications were experienced, and there was no recurrence of gastroesophageal reflux during a postoperative follow-up period of 12 months. The parents' final subjective evaluation of the outcomes 12 months after surgery was positive in 44 cases and negative in 4 cases.


CONCLUSIONS
Children with difficult-to-treat chronic respiratory symptoms must be evaluated for GERD, even if the need for surgery is low (8%), because complete eradication of reflux is mandatory. Radical treatment of GERD allows the pulmonologist to perform correct respiratory treatment and to prevent the development chronic and life-threatening complications.
Mattioli
G
G
Pediatric Surgery Unit, Giannina Gaslini Research Institute, University of Genova, Largo G. Gaslini 5, 16100 Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
Sacco
O
O
Gentilino
V
V
Martino
F
F
Pini Prato
A
A
Castagnetti
M
M
Montobbio
G
G
Jasonni
V
V
D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001249:Asthma / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004294:Domperidone / Q000627:therapeutic use; D015154:Esophageal Motility Disorders / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic; D009853:Omeprazole / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012120:Respiration Disorders / Q000209:etiology; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D004294:Domperidone; D009853:Omeprazole