Surgical management of gastroesophageal reflux disease (GERD) in children: A systematic review.
OBJECTIVE
The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the surgical treatment of pediatric gastroesophageal reflux disease (GERD).


METHODS
Five questions were addressed by searching the MEDLINE, Cochrane, Embase, Central, and National Guideline Clearinghouse databases using relevant search terms. Consensus recommendations were derived for each question based on the best available evidence.


RESULTS
There was insufficient evidence to formulate recommendations for all questions. Fundoplication does not affect the rate of hospitalization for aspiration pneumonia, apnea, or reflux-related symptoms. Fundoplication is effective in reducing all parameters of esophageal acid exposure without altering esophageal motility. Laparoscopic fundoplication may be comparable to open fundoplication with regard to short-term clinical outcomes. Partial fundoplication and complete fundoplication are comparable in effectiveness for subjective control of GERD. Fundoplication may benefit GERD patients with asthma, but may not improve outcomes in patients with neurologic impairment or esophageal atresia. Overall GERD recurrence rates are likely below 20%.


CONCLUSIONS
High-quality evidence is lacking regarding the surgical management of GERD in the pediatric population. Definitive conclusions regarding the effectiveness of fundoplication are limited by patient heterogeneity and lack of a standardized outcomes reporting framework.


METHODS
Systematic review of level 1-4 studies.


METHODS
Level 1-4 (mainly level 3-4).
Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap, Second Floor, Memphis, TN, 38105. Electronic address: tjancele@uthsc.edu.
Tim
T
Jancelewicz
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Monica E
ME
Lopez
Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, Program Director, Pediatric Surgery Fellowship, University of Louisville, Louisville, KY.
Cynthia D
CD
Downard
University of Florida, Gainesville, FL.
Saleem
S
Islam
Department of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC.
Robert
R
Baird
Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Shawn J
SJ
Rangel
Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap, Second Floor, Memphis, TN, 38105.
Regan F
RF
Williams
CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Meghan A
MA
Arnold
Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
Dave
D
Lal
Department of Surgery, Division of Pediatric Surgery, Albany Medical Center, Albany, NY.
Elizabeth
E
Renaud
Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL.
Julia
J
Grabowski
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH.
Roshni
R
Dasgupta
Department of Pediatric Surgery, The University of Texas Medical School at Houston and in Surgical Oncology and Pediatrics at the UT M.D., Anderson Cancer Center, Houston, TX.
Mary
M
Austin
Division of Pediatric Surgery, University of Iowa Children's Hospital, Iowa City, IA.
Julia
J
Shelton
Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Danielle
D
Cameron
Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA.
Adam B
AB
Goldin
D002648:Child; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D012008:Recurrence
Fundoplication; GERD; Gastroesophageal reflux disease; Systematic review