Original article
Outcomes of fundoplication in children with cystic fibrosis

https://doi.org/10.1016/j.jpedsurg.2007.03.030Get rights and content

Abstract

Purpose

Children with cystic fibrosis (CF) have a high prevalence of gastroesophageal reflux disease (GERD). As GERD is associated with chronic respiratory symptoms and feeding problems, fundoplication is often performed in children with CF. Although the outcomes of fundoplication have been described across diverse pediatric groups, there is no published experience with CF.

Methods

The records of 25 children with CF who underwent fundoplication in our center were reviewed. Data on symptoms and diagnostic testing results as well as on complications related to fundoplication were collected. Nutritional parameters and pulmonary function were compared before and after fundoplication.

Results

There was no mortality associated with fundoplication, but 12% had complications that required a subsequent surgical procedure. Whereas 28% were able to discontinue their antireflux medications, 48% developed symptoms of recurrent GERD. Overall, there was no change in body mass index, body mass index percentile, or the slope of forced expiratory volume in 1 second (FEV1) after fundoplication. Children who had an FEV1 of less than 60% predicted at the time of fundoplication exhibited an improvement in FEV1 slope compared to those with FEV1 of 60% or more (+5.3% vs −8.6% per year, P = .004).

Conclusion

The complication rate of fundoplication is similar to what has been reported in large series in children without CF. There is a high rate of recurrent GERD and little apparent benefit for either nutritional or pulmonary outcomes. The observed difference on FEV1 slope, in those with moderate-severe vs mild lung disease, highlights the need to thoroughly evaluate the role of fundoplication in children with CF.

Section snippets

Materials and methods

The records of the 25 children with CF who underwent laparoscopic Nissen fundoplication at our center from 1999 to 2005 were reviewed. Data regarding symptoms and diagnostic test results before fundoplication as well as complications after fundoplication were collected. Major complications were defined as those that required a subsequent surgical procedure, and minor complications were defined as signs and symptoms of recurrent GERD. Nutritional parameters including weight percentile (Wt%),

Results

The medical records of 25 subjects were reviewed with a median postfundoplication follow-up time of 30 months (range, 6-77 months). There were 12 males and 13 females, and the median age at fundoplication was 11 years (range, 2-16 years). Fourteen subjects were able to perform acceptable and reproducible spirometry. The preoperative symptoms suggestive of GERD as well as the results of diagnostic evaluation are summarized in Table 1, Table 2. There was no mortality because of fundoplication.

Discussion

Fundoplication was generally well tolerated in this study population, with no perioperative mortality and only 1 subject with a major postoperative complication. This major complication rate is similar to what was reported in a large multicenter series of 7464 children [15]. The authors of this study also reported a significant clinical improvement in preoperative symptoms in 94% of neurologically normal children, which is higher than the 52% symptomatic improvement rate in our sample. When

References (17)

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