title: Nissen fundoplication in infants and children: a long-term clinical study.
abstract: OBJECTIVE
  Infants and children who underwent open Nissen fundoplication for gastroesophageal reflux disease were retrospectively evaluated to assess the success and complications of this operation.
  
  
  METHODS
  Twenty-six neurologically normal children (16 boys and 10 girls between 6 months and 11 years old) underwent Nissen fundoplication for intractable or complicated gastroesophageal reflux between October 1982 and February 2002. Before surgery and at follow-up visits, all children were subjected to thorough history, barium meal study and gastroscopy with multiple esophageal biopsies. The median follow-up period was 28 months (range: 11 months-19 years).
  
  
  RESULTS
  Persistent vomiting or regurgitation since birth was the main symptom (24 patients, 92.3%), chest symptoms occurred in 5 patients (19.2%), malnutrition and retarded growth were found in 4 patients (15.4%), hematemesis and/or melena occurred in 2 patients (7.7%) and dysphagia due to esophageal stricture occurred in 4 patients (15.4%). There was no mortality. The mean hospital stay was 4.1 days. Twenty-two patients (84.6%) had no recurrent reflux. Reflux symptoms recurred in 4 cases (15.4%). One of these cases had no evidence of recurrent pathological reflux, 2 cases with preoperative stricture developed wrap disruption, recurrent reflux and re-stricture. Both refused a second operation. The fourth case developed melena and reflux esophagitis due to wrap herniation through the hiatus and was successfully managed by a second operation.
  
  
  CONCLUSIONS
  Nissen fundoplication is an effective operation to correct gastroesophageal reflux in infants and children when the drug therapy fails. The operation should be done before occurrence of complications to decrease the recurrence of reflux.
authors.affiliation: Gastroenterology Surgery Center, Mansoura University, Mansoura, Egypt. m_abu_zead@hotmail.com
authors.forename: Mostafa Abu
authors.initials: MA
authors.lastname: Zeid
authors.forename: Tharwat
authors.initials: T
authors.lastname: Kandel
authors.forename: Mohamed
authors.initials: M
authors.lastname: el-Shobary
authors.forename: Abd-Allah
authors.initials: AA
authors.lastname: Talaat
authors.forename: Amgad
authors.initials: A
authors.lastname: Fouad
authors.forename: Ahmed Abu
authors.initials: AA
authors.lastname: el-Enien
authors.forename: Tarek
authors.initials: T
authors.lastname: el-Badrawy
authors.forename: Nabil Gad
authors.initials: NG
authors.lastname: el-Hak
authors.forename: Mohamed Abd
authors.initials: MA
authors.lastname: el-Wahab
authors.forename: Farouk
authors.initials: F
authors.lastname: Ezzat
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors