Laparoscopic anterior hemifundoplication improves key symptoms without impact on GE in children with and children without neurodevelopmental delays.
OBJECTIVE
We investigated the impact of laparoscopic anterior hemifundoplication on gastric emptying (GE) and specific symptoms in children with and children without neurodevelopmental delays gastroesophageal reflux. Scintigraphic and ultrasonographic GE measurements were correlated.


METHODS
Twenty-six children (mean age 7 ± 6.1 years), of whom 14 were neurodevelopmentally delayed, were evaluated prospectively before 3 and 6 months after laparoscopic anterior hemifundoplication. All of the patients underwent clinical assessments, interviews, and 24-hour pH monitoring. Key symptoms were evaluated using a 5-point Likert scale. Gastric emptying was assessed by Tc-99m-DTPA-scintigraphy and ultrasonography.


RESULTS
All of the children had significant catch-up growth after fundoplication, which was more pronounced in the neurologically normal children (P < 0.05 vs impaired), in line with a decrease in the use of omeprazol (mean 0.93 ± 0.7 mg · kg(-1) · day(-1) before and 0.06 ± 0.18 mg · kg(-1) · day(-1) at 6 months after operation; P < 0.001). The 24-hour pH monitoring normalized in all of the children, and the mean severity of the key symptoms such as vomiting, choking, and pain was significantly reduced (P < 0.001). Scintigraphic GE parameters, such as the elimination rate/minute, gastric half-emptying time (t1/2), gastric residual activity (RA), and duration of the initial merging time, were not altered significantly by the operation (P > 0.05). Ultrasonographic evaluations confirmed these results [positive correlation with scintigraphy for t1/2 (P = 0.006) and RA (P = 0.01)]. The symptoms evolution and GE were uncorrelated (P > 0.01). There were no significant differences between children with and children without neurodevelopmental delays.


CONCLUSIONS
Laparoscopic anterior hemifundoplication achieves an excellent symptomatic outcome without affecting GE in children with and children without neurodevelopmental delays.
Departments of Pediatric Surgery, Hannover Medical School, Germany. ceng@bdc.de
Carsten
C
Engelmann
Stella
S
Gritsa
Klaus F
KF
Gratz
Benno M
BM
Ure
D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012720:Severity of Illness Index; D014463:Ultrasonography