E. Perrone1, J. Baerg1, R. Vannix1, D. Thorpe1, A. Gasior2, S. St Peter2 1Loma Linda University And Children’s Hospital,Pediatric Surgery,Loma Linda, CA, USA 2Children’s Mercy Hospital,Pediatric Surgery,Kansas City, MO, USA
Introduction: To compare outcome and quality of life variables in children with one Nissen fundoplication to those with redo Nissen fundoplications for gastroesophageal reflux disease (GERD).
Methods:
After IRB approval (#5100277), children younger than 18 years, from two children’s hospitals, with Nissen fundoplications or redo fundoplications performed between January 1995 and March 2011 were retrospectively reviewed.
Follow-up data were collected to December 2012. Phone calls were made to assess the current state of health for patients. Variables recorded included: hospital admissions for pneumonia, acute life threatening events (ALTEs), vomiting, retching, paraesophageal hernia on upper gastrointestinal (UGI) contrast study, need for esophageal dilations, operations for adhesive bowel obstruction, placement of gastro-jejunal (G-J) feeding tubes and administration of anti-GERD medications.
BMI z-scores at fundoplication, at one year after fundoplication, and at final follow-up evaluation were recorded. Children with one fundoplication were compared to those with redos using t-tests for continuous and chi-square tests for categorical variables. Means were expressed +/- standard deviation. A p-value <0.05 was considered significant.
Results:
The families of 212 children were contacted, which included 53.8% males, and 181 had one fundoplication (85.4%) and 31 had redos (14.6%). The median follow-up for the cohort was 3.4 years (range: 0.5-16 years) (mean: 4.1 +/- 2.9 years). The median time to first redo was 17 months (range: 1-108 months) (mean: 31.5 +/- 34.4 months). The median time to second redo after the 1st redo for 3/31(9.7%) was 32.5 months (range: 23-69 months) (mean: 41.5 +/- 24.3 months). One had a third redo 5 years after the second redo complicated by incarceration of small bowel in a para-esophageal hernia.
Comparison of Variables- see table
Conclusion:
Children with redo fundoplications have significant difficulties compared to children with one fundoplication on follow-up evaluation. They have significantly more admissions for pneumonia, vomiting, retching, paraesophageal hernias, and gastro-jejunal feeding tubes.
