Medizinische Universität Graz - Research portal
Selected Publication:
Duess, JW.
Outcome of Toupet-fundoplication in neurologically impaired children with GERD: experience of a single center
[ Diplomarbeit ] Medical University of Graz; 2011. pp. 105
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- Authors Med Uni Graz:
- Advisor:
- Höllwarth Michael
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- Abstract:
- Purpose: Children with severe neurological impairment (NI) frequently suffer from gastroesophageal reflux disease (GERD). It has been shown that these patients strongly benefit from antireflux procedures. While most studies prefer Nissen fundoplication, a recent study in adults has shown that in terms of long-term outcome Toupet fundoplication is superior to Nissen procedure. The aim of this retrospective study was to evaluate outcome and complications after Toupet fundoplication in neurologically impaired children (NIC). Methods: Data from January 2000 to December 2006 were retrospectively collected from patients who underwent a Toupet fundoplication. Pre- and postoperative workup included physical examination, oesophagogram, endoscopy, 24-h pH monitoring and impedance-pH monitoring. P-values <0,05 were considered statistically significant. Results: Forty-six patients with a median age of 5,5 years were identified. Preoperatively, the leading complaints were vomiting (60,9%), dysphagia (34,8%) and drinking difficulty (28,3%). Pathological reflux was recorded in most of the diagnostic procedures before surgery (75,6% in oesophagogram, 90% in 24-h pH monitoring, and 85,7% in impedance-pH monitoring). At Toupet fundoplication, an open procedure was performed in 18 (39,1%) and a laparoscopic one on 28 (60,9%) cases with a median duration of 163 minutes (53¿295). Median follow up was 24 months (1 month to 8 years). Postoperatively, most of the children showed an impressive improvement of symptoms and of results of diagnostic procedures (grade of reflux p<0,001, total Reflux Index p=0,007, number of all reflux episodes p=0,018). Relaparotomy was needed in 6 children (13%), redofundoplication in four (8,7%), laparotomy due to ileus in one, and gastropexy due to retching in an other patient. Conclusion: This study shows that Toupet fundoplication has a low complication rate and can be considered as a reliable and effective treatment of NIC with GERD. This positive outcome of Toupet fundoplication is certainly comparable to other antireflux procedures in children.