Preventive antireflux surgery in patients with congenital diaphragmatic hernia.
BACKGROUND
Gastroesophageal reflux (GER) is common in children with congenital diaphragmatic hernia (CDH), and the optimal management in these patients is not well established. The aim of this study was to assess whether a preventive fundoplication performed during the first surgery will improve GER and nutritional morbidity in patients with a left CDH.


METHODS
Thus we studied one group of 17 patients treated with a one-step antireflux procedure (group A) and a group of 19 patients with only initial diaphragmatic repair (group B) between January 1994 and December 2004. The patients were classified in three stages, mild intermediate and severe form, based on anatomic criteria (liver position and patch requirement). Most of the patients with the severe form of disease were in group A. Clinical charts were compared between the two groups with a mean follow-up of 3 years.


RESULTS
For patients with intra-abdominal liver and direct diaphragmatic closure, the duration of hospitalization was significantly longer in group A than in group B (p = 0.08). The incidence of GER was significantly lower in group A (17.6%) than in group B (52.6%) at 1-year follow-up (p < 0.5). In the last group, 30% required a fundoplication before 6 months. Seven patients (19%) required intermittent nutritional supplementation via nasogastric tube feeding; for these patients there was no difference between the two groups. A gastrostomy was performed in only one patient. Twelve percent of patients had growth retardation during most of their first year, again with no difference between the two groups.


CONCLUSIONS
Based on the published data, recommendations can be made regarding the efficacy of adding an antireflux surgery procedure to left CDH repair in only patients with intrathoracic liver and/or patch requirement.
Chamond
Caroline
C
Département de Chirurgie Pédiatrique, Hôpital Saint-Vincent de Paul, 74-82 av Denfert-Rochereau, 75014, Paris, France. caroline.chamond@svp.aphp.fr
Morineau
Marianne
M
Gouizi
Ghania
G
Bargy
Frederic
F
Beaudoin
Sylvie
S
D015331:Cohort Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010288:Parenteral Nutrition; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Eur J Pediatr Surg. 1995 Dec;5(6):323-6
8773221
J Pediatr Surg. 1997 Sep;32(9):1310-3
9314250
J Pediatr Surg. 2001 Aug;36(8):1171-6
11479850
J Pediatr Surg. 2002 Dec;37(12):1681-4
12483629
Eur J Pediatr Surg. 1991 Aug;1(4):244-6
1931848
J Pediatr Surg. 2006 May;41(5):888-92
16677876
J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):45-9
11176324
J Pediatr Surg. 1996 Aug;31(8):1096-9; discussion 1099-100
8863242
J Pediatr Surg. 1994 Sep;29(9):1262-5
7807363
J Pediatr Surg. 1995 Sep;30(9):1330-3
8523237
J Pediatr Surg. 1999 Jul;34(7):1127-9
10442606
Am J Surg. 1990 Feb;159(2):204-7
2405729
Eur J Pediatr Surg. 2000 Dec;10(6):360-4
11215775
Pediatr Surg Int. 2006 Apr;22(4):335-40
16456659
J Pediatr Surg. 1994 Feb;29(2):258-62; discussion 262-4
8176602
J Pediatr Surg. 1993 Jan;28(1):48-52
8429471
J Pediatr Surg. 1996 Dec;31(12):1651-4
8986979
Ann Thorac Surg. 2003 Jan;75(1):250-6
12537224
Clin Radiol. 1980 Mar;31(2):215-9
7363554
J Pediatr Surg. 1994 Nov;29(11):1447-51
7844718