The use of fundoplication for prevention of apparent life-threatening events.
OBJECTIVE
Gastroesophageal reflux disease (GERD) is cited by many to be a common cause of apparent life-threatening events (ALTEs). However, there are few reports in the literature regarding the surgical treatment of GERD to prevent a recurrent ALTE.


METHODS
A retrospective review of infants undergoing fundoplication between 2000 and 2005 for the prevention of another ALTE was undertaken. Preoperative, operative, and postoperative data as well as follow-up information were collected.


RESULTS
During the study period, 81 patients underwent fundoplication after presenting with an ALTE. All but 3 patients (96.3%) had been treated with antireflux medication. Moreover, 71 infants (87.7%) were taking antireflux medication at the time of their ALTE. A significant number of infants (77.8%) were hospitalized with a second ALTE before referral for fundoplication. After fundoplication, only 3 patients (3.7%) experienced a recurrent ALTE during the follow-up period; 2 required a second fundoplication and 1 underwent pyloromyotomy. None of these 3 patients have experienced a recurrent ALTE after the second operation. The median follow-up has been 1738 days.


CONCLUSIONS
Our data suggest that among patients who had an ALTE and are found to have GERD, fundoplication appears to be an effective method for preventing recurrent ALTE.
Valusek
Patricia A
PA
Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
St Peter
Shawn D
SD
Tsao
Kuojen
K
Spilde
Troy L
TL
Ostlie
Daniel J
DJ
Holcomb
George W
GW
D000402:Airway Obstruction / Q000209:etiology* / Q000517:prevention & control; D001049:Apnea / Q000209:etiology* / Q000517:prevention & control; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011708:Pylorus / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome