title: Long-term effects of fundoplication in children with chronic airway diseases.
abstract: BACKGROUND
  Association between chronic airway diseases (CAD) and gastroesophageal reflux disease (GERD) is well described, but causality has not yet been conclusively established. This study evaluates the therapeutic significance of laparoscopic Thal fundoplication in children with CAD and diagnosed GERD.
  
  
  METHODS
  We performed a retrospective analysis of 182 neurologically nonimpaired children, all with medically refractory CAD and GERD undergoing laparoscopic Thal fundoplication. The clinical response, ability to wean oral and inhaled medication and satisfaction with postoperative results were evaluated.
  
  
  RESULTS
  Main symptoms disappeared completely in 68.7% of patients and were markedly improved in a further 22% of patients following surgery. Complete discontinuation of medication was achieved in 70.1-96.4% of cases and reduced in a further 1.8-23.5%. One intraoperative complication occurred (gastric perforation), however no conversion to laparotomy was necessary. Postoperative Dumping Syndrome occurred in 1% of cases and was managed dietetically. Prolonged postoperative dysphagia occurred in 4.3% of patients, but disappeared within 8 weeks in all but one case.
  
  
  CONCLUSIONS
  Our study suggests that Thal fundoplication in neurologically nonimpaired children with CAD and documented GERD is effective and safe. Children unresponsive to preoperative medical management showed significant improvement in airway symptoms together with a marked reduction in the need for medication. We conclude that laparoscopic Thal fundoplication represents a significant treatment worthy of consideration in this group of patients.
authors.affiliation: Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany. Electronic address: gio@frongia.net.
authors.forename: G
authors.initials: G
authors.lastname: Frongia
authors.affiliation: Department of Pediatric Pulmonology and Allergology, Kinderkliniken Prinzessin Margaret, Darmstadt, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Ahrens
authors.affiliation: Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Capobianco
authors.affiliation: Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kössler-Ebs
authors.affiliation: Department of Pediatric Pulmonology and Allergology, Kinderkliniken Prinzessin Margaret, Darmstadt, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Stroh
authors.affiliation: Department of Pediatric Pulmonology and Allergology, Kinderkliniken Prinzessin Margaret, Darmstadt, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Fritsche
authors.affiliation: Department of Pediatric Pulmonology and Allergology, Kinderkliniken Prinzessin Margaret, Darmstadt, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Lettgen
authors.affiliation: Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kessler
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mehrabi
authors.affiliation: Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Günther
authors.affiliation: Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Holland-Cunz
mesh_terms: D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012140:Respiratory Tract Diseases / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Asthma; Children; Chronic airway disease; Gastroesophageal reflux disease; Laparoscopic Thal fundoplication