title: Preventive antireflux surgery in neonates with congenital diaphragmatic hernia: a single-blinded prospective study.
abstract: OBJECTIVE
  Congenital diaphragmatic hernia (CDH) is known to be a predisposing factor in gastroesophageal reflux (GER) leading to pulmonary and nutritional problems. The aim of this prospective, randomized, patient-blinded study was to evaluate the benefit of antireflux surgery at the time of CDH repair.
  
  
  METHODS
  From 2003 to 2009, 79 neonates with left-sided CDH were included. Forty-three had regular hernia closure. Thirty-six patients additionally had fundoplication at hernia repair. Follow-up was at 6, 12, and 24 months after birth with a standardized questionnaire and a thorax radiograph. Patients with clinical signs for GER were evaluated with upper gastrointestinal series and 24-hour pH-metry.
  
  
  RESULTS
  Seventy-nine of 263 patients participated in this prospective trial. Survival rate was 88.61%. The GER symptoms were almost significantly more frequent in the group without concomitant fundoplication at the age of 6 months. At 24 months, the difference between both groups was not significant anymore. Development of body weight in the first 2 years of life was similar in both groups. No complications related to initial antireflux surgery were noted.
  
  
  CONCLUSIONS
  Patients profit from fundoplication at CDH repair only within the first year of life. At the present point of this study, simultaneous fundoplication at the time of primary CDH repair cannot be recommended as a standard procedure in all patients with left-sided CDH.
authors.affiliation: Department of Pediatric Surgery, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim 68167, Germany. sausai@web.de
authors.forename: Susanne
authors.initials: S
authors.lastname: Maier
authors.forename: Katrin
authors.initials: K
authors.lastname: Zahn
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Wessel
authors.forename: Thomas
authors.initials: T
authors.lastname: Schaible
authors.forename: Joachim
authors.initials: J
authors.lastname: Brade
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinshagen
mesh_terms: D000367:Age Factors; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000401:mortality / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D016896:Treatment Outcome; D015430:Weight Gain