Abstract
Aim of the study
Conservative management of gastrooesophageal reflux (GORD) in oesophageal atresia
(OA) is sometimes inefficient, and fundoplication is required. We assessed the outcomes
of fundoplication among OA patients from 1980 to 2016.
Methods
After ethical consent, hospital records of 290 patients, including 22 referred patients,
were reviewed. Included were 262 patients with end–to–end repair. Excluded were patients
who underwent oesophageal reconstruction (n = 23) or no repair (n = 5). Primary outcome measures included survival, retaining the native oesophagus, resolution
of GGORD symptoms, failure of fundoplication, and long-term endoscopic results.
Main results
Gross types of OA in 262 patients were A (n = 12), B (n = 2), C (n = 217), D (n = 10), E (n = 19), and F (n = 2). Eighty-six (33%) patients, type A (n = 12, 100%), B (n = 2, 100%), C (n = 69, 31%), D (n = 3, 30%), and F (n = 1, 50%), underwent fundoplication at the median age of 5.4 (IQR 3.1–16) months. Main
indications included recalcitrant anastomotic stenosis (RAS) in 41 (48%), respiratory
symptoms in 16 (19%), and acute life threatening events (ALTE) in 15 (17%) of patients.
Associated tracheomalacia in 25 (29%) patients were treated with aortopexy. Median
follow–up was 7.5 (IQR 1.8–15) years. RAS resolved in 30 (73%) patients, whereas 11
(27%) with unresolved RAS underwent oesophageal resection (n = 8) or replacement (n = 3). Six (7%) patients died of heart failure (n = 4), bolus impaction (n = 1), and ALTE (n = 1). Fundoplication failed in 27 (31%) patients, and 13 (15%) underwent redo fundoplication.
Fundoplication failure was predicted by long-gap OA RR = 3.8 (95%CI = 1.1–13), P = 0.04. In total GORD associated symptoms persisted in 7 (8%) patients, including one
with permanent feeding jejunostomy. Latest endoscopy showed moderate or severe oesophagitis
in 7% of fundoplicated and in 3% nonfundoplicated patients and intestinal metaplasia
in 3% and 1% (p = 0.20–0.29).
Conclusion
Fundoplication provided a safe and relatively effective control of OA associated symptomatic
GORD and oesophagitis. The failure rate of fundoplication was high in those with long-gap
OA.
Type of study
Treatment study.
Level of evidence
IV
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Congenital anomalies of the esophagus.in: Coran A.G. Adzick N.S. Krummel T.M. Laberge J.M. Shamberger R.C. Caldamone A.A. 7th ed. Pediatric surgery. vol. 2. Elsevier; Saunders, 2012: 853-926
- Gastroesophageal reflux disease.in: Coran A.G. Adzick N.S. Krummel T.M. Laberge J.M. Shamberger R.C. Caldamone A.A. 7th ed. Pediatric surgery. vol. 2. Elsevier; Saunders, 2012: 947-958
- Outcome and management in infants with esophageal atresia - a single centre observational study.J Pediatr Surg. 2016; 51: 1421-1425
- Long-term analysis of children with esophageal atresia and tracheoesophageal fistula.J Pediatr Surg. 2003; 38: 852-856
- Long-term outcome of children with oesophageal atresia type III.Arch Dis Child. 2012; 97: 808-811
- Revisional surgery for recurrent tracheoesophageal fistula and anastomotic complications after repair oesophageal atresia in 258 infants.J Pediatr Surg. 2015; 50: 250-254
- Modern outcomes of oesophageal atresia: single centre experience over the last twenty years.J Pediatr Surg. 2013; 48: 297-303
- Long‐term outcomes of oesophageal atresia without or with proximal tracheooesophageal fistula — gross types A and B.J Pediatr Surg. 2017; 52: 1571-1575
- Esophageal morbidity and function in adults with repaired esophageal atresia with tracheoesophageal fistula: a population-based long-term follow-up.Ann Surg. 2010; 251: 1167-1173
- Endoscopic surveillance after repair of oesophageal atresia: longitudinal study in 209 patients.J Pediatr Gastroenterol Nutr. 2016; 62: 562-566
- Fundoplication in patients with esophageal atresia: patient selection, indications, and outcomes.Front Pediatr. 2017; https://doi.org/10.3389/fped.2017.00109
- Outcome of surgery for pediatric gastroesophageal reflux-clinical and endoscopic follow-up after 300 fundoplications in 279 consecutive patients.Scand J Surg. 2017; ([Epub ahead of print])https://doi.org/10.1177/1457496917698641
- Esophagoscopy and diagnostic techniques.in: Coran A.G. Adzick N.S. Krummel T.M. Laberge J.M. Shamberger R.C. Caldamone A.A. 7th ed. Pediatric surgery. vol. 2. Elsevier: Saunders, 2012: 881-887
- Healing and relapse of severe peptic esophagitis after treatment with omeprazole.Gastroenterology. 1988; 95: 903-912
- Histological consequences of gastroesophageal reflux in man.Gastroenterology. 1970; 58: 163-174
- Chronic esophagitis and gastric metaplasia are frequent late complications of esophageal atresia.J Pediatr Surg. 1993; 28: 1178-1180
- Esophageal atresia: gastroesophageal functional follow-up in 5-15 year old children.J Pediatr Surg. 2013; 48: 2487-2495
- Failed Nissen fundoplication in children: causes and management.Eur J Pediatr Surg. 2014; 24: 79-82
- Anti-reflux surgery for patients with esophageal atresia.Dis Esophagus. 2013; 26: 401-404
- Immunohistochemistry for CDX2 expression in non-goblet cell Barrett's oesophagus.Br J Biomed Sci. 2014; 71: 86-92
Article info
Publication history
Published online: December 08, 2017
Accepted:
November 8,
2017
Received:
October 29,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
