Long-term results of anterior gastropexy for gastroesophageal reflux in children

Abstract

Between 1971 and 1985, anterior gastropexy was performed in 154 children (age 1 month to 16 years, 92 younger than 1 year) for gastroesophageal reflux demonstrated by barium swallow (diagnostic in 84%), endoscopy (92%), and 24-h pH monitoring (86%). The main indications for surgery were: vomiting and failure to thrive (106 cases); apneic spells (14); recurrent respiratory infections (14); stricture (12); and substernal pain (8). Two complications occurred intraoperatively (hemorrhage and esophageal perforation) and 27 postoperatively (pneumonia 9; intestinal obstruction 6; hiatal stenosis subsequent to operation 5; delayed gastric emptying 2; gas bloating 2; paraesophageal hernia 2; gastric perforation 1), all without mortality. Long-term (1–13 years, 40 more than 5 years) follow-up was available in 143 cases (93%); the operation was considered successful in 121 (92%). Success rates for each indication were as follows: vomiting 94%; apneic spells 100%; respiratory infections 83%; stricture 67%; pain 100%. Twelve failures (8%) were noted: uncomplicated recurrent reflux in 8 patients, of whom 2 were reoperated; recurrent peptic stricture in 4, 3 reoperated. All reoperations were successful. This long-term follow-up shows that anterior gastropexy is a safe operation in children with an high success rate, particularly in cases of uncomplicated gastroesophageal reflux.