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Laparoscopic Thal Fundoplication in Children: A Prospective 10- to 15-Year Follow-up Study

Mauritz, Femke A. MD*,†; van Herwaarden-Lindeboom, Maud Y. A. MD, PhD*; Zwaveling, Sander MD, PhD*; Houwen, Roderick H. J. MD, PhD; Siersema, Peter D. MD, PhD; van der Zee, David C. MD, PhD*

Annals of Surgery:
doi: 10.1097/SLA.0b013e318294102e
Original Articles
Abstract

Objective: To study long-term (10–15 years) efficacy of antireflux surgery (ARS) in a prospectively followed cohort of pediatric patients with gastroesophageal reflux disease, using 24-hour pH monitoring and reflux-specific questionnaires.

Background: Studies on short-term outcome of ARS in pediatric patients with gastroesophageal reflux disease have shown good to excellent results; however, long-term follow-up studies are scarce, retrospective, and have not used objective measurements.

Methods: Between 1993 and 1998, a cohort of 57 pediatric patients (ages 1 month to 18 years; 46% with neurological impairment) underwent laparoscopic anterior partial fundoplication (Thal). Preoperatively and postoperatively (at 3–4 months and at 1–5 and 10–15 years), reflux-specific questionnaires were filled out, and 24-hour pH monitoring was performed.

Results: At 3 to 4 months, at 1 to 5 years, and at 10 to 15 years after ARS, 81%, 80%, and 73% of patients, respectively, were completely free of reflux symptoms. Disease-free survival analysis, however, demonstrated that only 57% of patients were symptom free at 10 to 15 years after ARS. Total acid exposure time significantly decreased from 13.4% before ARS to 0.7% (P < 0.001) at 3 to 4 months after ARS; however, at 3 to 4 months after ARS, pH monitoring was still pathological in 18% of patients. At 10 to 15 years after ARS, the number of patients with pathological reflux had even significantly increased to 43% (P = 0.008). No significant differences were found comparing neurologically impaired and normally developed patients.

Conclusions: As gastroesophageal reflux persists or recurs in 43% of children 10 to 15 years after laparoscopic Thal fundoplication, it is crucial to implement routine long-term follow-up after ARS in pediatric patients with gastroesophageal reflux disease.

In Brief

Long-term (10&amp;#x2013;15 years) efficacy was evaluated in a prospectively followed cohort of 57 pediatric patients who had undergone laparoscopic antireflux surgery (ARS). After 10 to 15 years, 43% of patients had reflux symptoms and pathological reflux on 24-hour pH monitoring. Therefore, routine long-term follow-up must be implemented after ARS.

Author Information

*Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands; and

Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.

Reprints: Femke A. Mauritz, MD, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands. E-mail: f.a.mauritz@umcutrecht.nl.

Disclosure: F. A. Mauritz is supported by an unrestricted grant provided by the Wilhelmina Children's Hospital fund. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.