Persistent gastroesophageal reflux disease (GORD) is one of the most frequent disorders for which infants and children undergo abdominal surgery. However, most children with GORD may be treated non-surgically. Appropriate therapy for GORD is based on the underlying presentation and accurate interpretation of diagnostic test results.
Nearly all infants have some degree of GOR, but it is usually short-lived. However, in some children, the reflux is crippling and persistent, causing feeding difficulties, failure to gain weight, aspiration or respiratory complications, Oesophagitis, and Oesophageal stricture. GORD occurs on a continuing to a severe debilitating problem.
Neurologically impaired children, including those with mental-motor disorders, seizure disorders, and hydrocephalus, appear to have a higher prevalence of GOR after age 1 year than neurologically normal children. Other factors implicated in the presence of GORD, include abnormal or altered anatomy, such as hiatal hernia, short Oesophagus, and gastrostomy.
Surgical therapy for gastroesophageal reflux disease (GORD) has evolved a great deal. Some historical procedures include the Allison crural repair, the Boerema anterior gastropexy, and the Angelchik prosthesis. Both the Allison and the Boerema repairs have high failure rates and are rarely, if ever, used. The Angelchik prosthesis is a silicone ring that is positioned at the gastroesophageal junction and prevents reflux. The Angelchik prosthesis was rarely used in children and has been largely abandoned because of a high rate of complications.
The most commonly performed operation today in both children and adults is the Nissen fundoplication, which is a 360° transabdominal fundoplication.
First reported in 1991, laparoscopic fundoplication was well studied in adults. More recently, Laparoscopic fundoplication has also quickly gained acceptance for use in children.
Antireflux surgery is be considered when medical therapy fails (ie, when patients have continued symptoms, or complications of GORD).