Experience with the Nissen Fundoplication for Correction of Gastroesophageal Reflux in Infants

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Abstract
In the past 15 years at Children's Hospital in Washington, D.C., approximately 500 infants under 1 year of age have been evaluated because of symptomatic gastroesophageal reflux. A contrast esophagogram will demonstrate reflux in the majority of affected infants. However, this diagnostic method is not always reliable. Timed monitoring of esophageal pH, and extended radionuclide scan even in infants can document accurately the frequency and character of episodic reflux. Following diagnosis, most infants are treated by conservative therapy, which includes the upright position. Of the 500 patients, 72 infants (14%) were selected for operative correction using the Nissen fundoplication. The indications for surgery in these infants with gastroesophageal reflux were: (A) failure to thrive, (35); (B) chronic respiratory infection, (24); (C) apnea spells, (8); and (D) esophagitis. One infant was found to have a stricture. In these symptomatic patients, three had previous operative correction of esophageal atresia, and two had congenital gastric dislocation in the chest. Results: 61 excellent; six recurrences, of whom five are satisfactory after a second operation; two lost to follow-up but doing well when last seen; three deaths from causes unrelated to reflux. The selection of infants with gastroesophageal reflux for surgical correlation is primarily based on life-threatening clinical effects. The Nissen fundoplication has worked well in this group of infants.