title: Anterior fundoplication at the time of congenital diaphragmatic hernia repair.
abstract: OBJECTIVE
  The loss of normal anatomic barriers in neonates with congenital diaphragmatic hernia (CDH) can predispose children to gastroesophageal reflux (GER). In an attempt to improve post-operative feeding, we have added a modified anterior fundoplication to restore natural gastric and esophageal positioning.
  
  
  METHODS
  The institutional review board of both participating centers approved this study. Between 1997 and 2008, 13 neonates with high-risk anatomy underwent repair of CDH combined with an anterior fundoplication (Boix-Ochoa). The anatomic indications for concomitant fundoplication were absence of an intra-abdominal esophagus, an obtuse angle of His, and a small, vertically oriented stomach.
  
  
  RESULTS
  Ten patients survived to discharge and eight were on full oral nourishment. One required partial gastrostomy feedings for an improving oral aversion and quickly progressed to full oral feedings. One patient with chromosomal anomalies and swallowing dysfunction remained on long-term bolus gastrostomy feedings. Two with progressive symptoms of GER and failure to thrive required conversion to a 360 degrees wrap after 18 months of medical management. This was performed in conjunction with a planned, staged muscle flap reconstruction in one patient. There were no complications related to the fundoplication.
  
  
  CONCLUSIONS
  Anatomic predictors of severe GER can be efficiently countered at the time of CDH repair. A modified fundoplication should be considered in the operative management of high-risk infants.
authors: Department of General Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA. yguner@chla.usc.edu
authors: Yigit S
authors: YS
authors: Guner
authors: Steven
authors: S
authors: Elliott
authors: Clifford C
authors: CC
authors: Marr
authors: Stephen K
authors: SK
authors: Greenholz
mesh_terms: D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn