title: Effects and efficacy of laparoscopic fundoplication in children with GERD: a prospective, multicenter study.
abstract: Laparoscopic antireflux surgery (LARS) in children primarily aims to decrease reflux events and reduce reflux symptoms in children with therapy-resistant gastroesophageal reflux disease (GERD). The aim was to objectively assess the effect and efficacy of LARS in pediatric GERD patients and to identify parameters associated with failure of LARS.
  
  
  
  Twenty-five children with GERD [12 males, median age 6 (2-18) years] were included prospectively. Reflux-specific questionnaires, stationary manometry, 24-h multichannel intraluminal impedance pH monitoring (MII-pH monitoring) and a13C-labeled Na-octanoate breath test were used for clinical assessment before and 3 months after LARS.
  
  
  
  After LARS, three of 25 patients had persisting/recurrent reflux symptoms (one also had persistent pathological acid exposure on MII-pH monitoring). New-onset dysphagia was present in three patients after LARS. Total acid exposure time (AET) (8.5-0.8 %; p < 0.0001) and total number of reflux episodes (p < 0.001) significantly decreased and lower esophageal sphincter (LES) resting pressure significantly increased (10-24 mmHg, p < 0.0001) after LARS. LES relaxation, peristaltic contractions and gastric emptying time did not change. The total number of reflux episodes on MII-pH monitoring before LARS was a significant predictor for the effect of the procedure on reflux reduction (p < 0.0001).
  
  
  
  In children with therapy-resistant GERD, LARS significantly reduces reflux symptoms, total acid exposure time (AET) and number of acidic as well as weakly acidic reflux episodes. LES resting pressure increases after LARS, but esophageal function and gastric emptying are not affected. LARS showed better reflux reduction in children with a higher number of reflux episodes on preoperative MII-pH monitoring.
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands. femkemauritz@gmail.com.|Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. femkemauritz@gmail.com.
authors.forename: Femke A
authors.identifier: 0000-0003-1829-4695
authors.initials: FA
authors.lastname: Mauritz
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Conchillo
authors.affiliation: Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: L W E
authors.initials: LWE
authors.lastname: van Heurn
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: C E J
authors.initials: CEJ
authors.lastname: Sloots
authors.affiliation: Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R H J
authors.initials: RHJ
authors.lastname: Houwen
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
authors.forename: D C
authors.initials: DC
authors.lastname: van der Zee
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
authors.forename: M Y A
authors.initials: MYA
authors.lastname: van Herwaarden-Lindeboom
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology; D049630:Esophageal Sphincter, Lower / Q000502:physiology; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D011183:Postoperative Complications; D011312:Pressure; D011446:Prospective Studies
keywords: Children; Efficacy; Fundoplication; GERD; Pediatric; Reflux