Long-term Outcomes of Children with Gastroesophageal Reflux Disease Who Underwent Fundoplication: A Single Center Experience
Supawadee Sawaskeaw, MD1, Paisarn Vejchapipat, MD, PhD2, Katawaetee Decharun, MD2, Voranush Chongsrisawat, MD1
Affiliation : 1 Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand 2 Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background : Fundoplication is indicated in patient with gastroesophageal reflux disease (GERD) who need long-term medication,
fail to response to optimal medication therapy, or have life-threatening complication.
Objective : To evaluate the outcome of GERD patients at 12 months after fundoplication.
Materials and Methods: This retrospective study includes children who were diagnosed GERD and underwent fundoplication
between January 2006 and December 2018 at King Chulalongkorn Memorial Hospital. Studied outcomes were the need of antireflux
medications, prevalence of persistent symptoms, GERD-related hospitalization rate, re-operation rate, and mortality rate at 12
months after fundoplication.
Results : Overall, 59 patients (49% male) were included in the present study. The median age (IQR) at the time of GERD diagnosis
and fundoplication was 11 (5 to 48) and 18 (8 to 66) months, respectively. All children had comorbid conditions, the most common
of which was neurological impairment (n = 48, 81%). Fifty-seven and 2 patients underwent Nissen and Thal fundoplication,
respectively. At 12-month follow-up, 30 (51%) were prescribed antireflux medications and 25 (42%) had persistent GERD
symptoms. The median (IQR) hospitalization rate was 2.5 (2 to 3) times/year. Only 1 (1.7%) patient, who had esophageal atresia
and tracheoesophageal fistula, underwent reoperation due to fundoplication disruption. There were 9 deaths (15.3%). Causes of
death were GERD-related aspiration pneumonia (n = 1), sepsis (n = 5), hospital-acquired pneumonia (n = 2), and recurrent
ependymoma (n = 1).
Conclusion : Most patients with GERD who have comorbid conditions have persistent symptoms and need continuing antireflux
medications after fundoplication. Therefore, long-term follow-up of GERD patients following fundoplication is essential, particularly
those at risk of a high failure rate of fundoplication.
DOI: 10.35755/jmedassocthai.2020.S08.12007
Keywords : Children, Fundoplication, Gastroesophageal reflux disease, GERD, Outcome
