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Esposito, C.1; Langer, J.2; Schaarshmidt, K.3; Mattioli, G.4; Settimi, A.5; Jasonni, V.6

Journal of Pediatric Gastroenterology and Nutrition: June 2004 - Volume 39 - Issue - p S14-S15
ABSTRACTS: Oral Presentation Abstracts

1Experimental and Clinical Medicine, Chair of Pediatric Surgey, Catanzaro, Italy,2General and Pediatric Surgery, Hospital for Sick Children, Toronto, Canada,3Pediatric Surgey, Helios Klinicum Buch, Berlin, Germany,4Pediatric Surgey, Gaskini Foundation, Genova,5Pediatric Surgey, Federico II University, Naples,6Pediatric Surgey, Gaslini Foundation, Genova, Italy

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Introduction: Gastroesophageal reflux (GER) is a major cause of complications after esophageal atresia repair. The validity of the results of open fundoplications in these patients is still disputed.

Methods: From 1998 to 2002, 350 children underwent LARP.Twenty-one/350 patients (6%) were operated at birth for esophageal atresia repair. Our study focused only on the management of these 21 patients.Their age ranged from 6 months to 8 yrs. Five of them (23.8%) were neurologically impaired children (NIC). The indication for surgey were GER and aspirations in all; in addition 5 patients presented severe esophagitis with peptic stricture (23.8%)and other 5 (23.8%) feeding problems. One child had a VACTERL syndrome. All patients had already been treated with proton pump inhibitors without appreciable results. All patients underwent antireflux procedures using laparoscopy: 9 pts (42.8%) according to Nissen; 9 (42.8%) according to Thal and 3 (14.4%) according to Toupet. The 5 NIC with feeding problems underwent concomitant g-tube placement.

Results: Hospital stay varied from 2 to 9 days.Follow-up varied between 12 months and 6 yrs.All patients were evaluated with a 24-hours Ph-metry and barium swallow. The 16/21 neurologically normal children are free of symptoms without need for medical therapy. Five/16 (31.2%) of them presented mild dysphagia that disappeared spontaneously within 3–6 months. As for the 5 NIC: one patient eats only through a g-tube, the other four undergo mixed feeding; none have signs of GER, but two of them still present respiratory symptoms, and one has a delayed gastric emptying.

Conclusion: Laparoscopic antireflux surgery after esophageal atresia repair is an effective procedure to perform. In our experience the three procedures adopted (Nissen, Thal, Toupet) seem to give comparable results in expert hands; 31.2 % of short term dysphagia can be due to a primary dismotility of the esophagus consequent to the esophageal atresia. Considering that over 20 % of patients presented severe esophagitis with peptic stenosis at the moment of the operation, the indication for surgery could perhaps be anticipated to avoid the complications deriving from the prolonged period on medical therapy. In conclusion, laparoscopic antireflux procedures in patient with GER operated at birth for esopahgeal atresia,in our series seem to give better results compared to those reported in the international literature using open surgery.

© 2004 Lippincott Williams & Wilkins, Inc.