title: The use of fundoplication for prevention of apparent life-threatening events.
abstract: 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.
authors.affiliation: Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Valusek
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Kuojen
authors.initials: K
authors.lastname: Tsao
authors.forename: Troy L
authors.initials: TL
authors.lastname: Spilde
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
mesh_terms: 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