[Clinical and endoscopic outcome after Nissen fundoplication for gastroesophageal reflux disease].
BACKGROUND
The surgical treatment of gastroesophageal reflux disease is indicated in patients with a chronic condition when proton pump inhibitors therapy is ineffective or when symptoms are persistently recurrent. Fundoplication failure occurrence has been detected in some patients and highlights a needing of monitoring esophageal post-surgical condition since that clinical symptoms are not sensitive enough for indicating fundoplication failure.


OBJECTIVE
To identify the frequency of a disrupted wrap in the postoperative period and to evaluate esophageal complications related with gastroesophageal reflux recurrence in children and adolescents.


METHODS
The study was cross-sectional, prospective and descriptive, including 45 patients (16 months-16.9 years) who had undergone Nissen fundoplication in a school hospital. Twenty six patients (57.8%) were neurologically impaired. Upper gastrointestinal endoscopy was performed in order to determine fundoplication integrity, endoscopic and histopathological esophageal condition. Upper gastrointestinal endoscopies were performed from 12 up to 30 months after surgery.


RESULTS
Patent wrap was identified in 41 patients (91.1%). Recurrent peptic esophagitis was found in 6 of 45 patients, 2 of which required a second fundoplication and other two had Barrett esophagus. Endoscopic peptic esophagitis was associated with a defective wrap (P = 0.005). Conclusions - Fundoplication was effective for treating esophagitis, even in patients with previous esophageal stenosis. Endoscopic follow up may detect surgery failure in children undergone anti-reflux surgery even in asymptomatic patients.
Vicente
Alessandra Maria Borges
AM
Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP. ambv@bol.com.br
Cardoso
Sílvia Regina
SR
Servidoni
Maria de Fátima Correia Pimenta
Mde F
Meirelles
Luciana Rodrigues de
LR
Silva
Joaquim Murray Bustorff
JM
Costa-Pinto
Elizete Aparecida Lomazi da
EA
D000293:Adolescent; D001925:Brain Damage, Chronic / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004941:Esophagitis / Q000209:etiology / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome