Original Contribution
The American Journal of Gastroenterology (2005) 100, 1844–1852; doi:10.1111/j.1572-0241.2005.41763.x
Antireflux Surgery Outcomes in Pediatric Gastroesophageal Reflux Disease
Diego M Diaz MD, MSc1, Troy E Gibbons MD2, Kurt Heiss MD3, Mark L Wulkan MD3, Richard R Ricketts MD3 and Benjamin D Gold MD1
- 1Pediatric Gastroenterology and Nutrition, Emory University School of Medicine, Atlanta, Georgia;
- 2Pediatric Gastroenterology and Nutrition, University of Arkansas, Little Rock, Arkansas;
- 3Pediatric Surgery, Emory University School of Medicine, Atlanta, Georgia
Correspondence: Benjamin D Gold, MD, Department of Pediatrics, Emory University School of Medicine, Division of Pediatric Gastroenterology and Nutrition, 2015 Uppergate Drive Building, Atlanta, GA 30322
Received 3 November 2004; Revised 0000; Accepted 10 March 2005.
Abstract
OBJECTIVES:
Antireflux surgery is performed frequently in children with gastroesophageal reflux disease (GERD). Few comparative studies exist which assess the indications for and short- or long-term outcome of open Nissen fundoplication (ONF) and laparoscopic Nissen fundoplication (LNF) for pediatric GERD. We investigated the frequency of reoperation and factors that might influence its occurrence.
METHODS:
We performed a retrospective, follow up cohort study of all children 
5 years, who underwent LNF or ONF at our institution from January 1, 1997 to December 31, 2002, where five pediatric surgeons perform fundoplication. Mean follow up time was 36.2 months. The following information was obtained: surgical indications, hospital course data, and long-term surgical outcomes. Data were analyzed using univariate and multiple logistic regressions.
RESULTS:
Overall, 456 (150 [32.9%] ONF vs. 306 [67.1%] LNF) cases were analyzed. Reoperation was performed in 55 (12.06%), LNF 43 (14.05%), and ONF 12 (8%). The mean interim to reoperation for LNF was 11 months compared to 17 months for ONF (p= 0.007). The reoperation rate at 12 and 24 months were 10.5%, 13.4% and 4%, 6.7% respectively, when LNF was compared to ONF (p= 0.01). The multivariate analysis showed that initial LNF and prematurity were the main predictors for reoperation.
CONCLUSIONS:
The majority of reoperations for both LNF and ONF occurred in the first year after initial operation; LNF had a significantly higher reoperation rate than ONF. The probability of reoperation for LNF and ONF increases with the presence of comorbidities, especially prematurity and chronic respiratory conditions.
