title: Long-term outcome and need of re-operation in gastro-esophageal reflux surgery in children.
abstract: BACKGROUND
  Fundoplication is considered a mainstay in the treatment of gastro-esophageal reflux. However, the literature reports significant recurrences and limited data on long-term outcome.
  
  
  OBJECTIVE
  To evaluate our long-term outcomes of antireflux surgery in children and to assess the results of redo surgery.
  
  
  METHODS
  We retrospectively analyzed all patients who underwent Nissen fundoplication in 8 consecutive years. Reiterative surgery was indicated only in case of symptoms and anatomical alterations. A follow-up study was carried out to analyzed outcome and patients' Visick score assessed parents' perspective.
  
  
  RESULTS
  Overall 162 children were included for 179 procedures in total. Median age at first intervention was 43 months. Comorbidities were 119 (73 %), particularly neurological impairments (73 %). Redo surgery is equal to 14 % (25/179). Comorbidities were risk factors to Nissen failure (p = 0.04), especially children suffering neurological impairment with seizures (p = 0.034). Follow-up datasets were obtained for 111/162 = 69 % (median time: 51 months). Parents' perspectives were excellent or good in 85 %.
  
  
  CONCLUSIONS
  A significant positive impact of redo Nissen intervention on the patient's outcome was highlighted; antireflux surgery is useful and advantageous in children and their caregivers. Children with neurological impairment affected by seizures represent significant risk factors.
authors.affiliation: DINOGMI, University of Genoa, Genoa, Italy. vrossi9@ymail.com.|Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Largo G. Gaslini 5, 16100, Genoa, Italy. vrossi9@ymail.com.
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.affiliation: Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Largo G. Gaslini 5, 16100, Genoa, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Mazzola
authors.affiliation: DINOGMI, University of Genoa, Genoa, Italy.|Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Largo G. Gaslini 5, 16100, Genoa, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Leonelli
authors.affiliation: Pediatric Gastroenterology Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gandullia
authors.affiliation: Pediatric Gastroenterology Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Arrigo
authors.affiliation: Pediatric Neuromuscular Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Pedemonte
authors.affiliation: Pediatric Neuromuscular Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Schiaffino
authors.affiliation: Pediatric Neuromuscular Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Mancardi
authors.affiliation: Pediatric Pulmonary and Allergy Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Oliviero
authors.initials: O
authors.lastname: Sacco
authors.affiliation: Department of Pediatric Anesthesia, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Nicola Massimo
authors.initials: NM
authors.lastname: Disma
authors.affiliation: Department of Pediatric Anesthesia, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Zanaboni
authors.affiliation: Department of Pediatric Anesthesia, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montobbio
authors.affiliation: Pediatric Gastroenterology Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Genoa, Italy.
authors.forename: Arrigo
authors.initials: A
authors.lastname: Barabino
authors.affiliation: DINOGMI, University of Genoa, Genoa, Italy.|Paediatric Surgery Unit, Giannina Gaslini Children's Hospital, Institute for Scientific Research, Largo G. Gaslini 5, 16100, Genoa, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Children; Follow-up; Nissen fundoplication