gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

The effects of laparoscopic Thal fundoplication on children with severe reactive airway disease and gastroesophageal reflux disease

Meeting Abstract

Suche in Medline nach

  • Giovanni Frongia - Chirurgische Universitätsklinik Heidelberg, Sektion Kinderchirurgie, Heidelberg

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch487

doi: 10.3205/14dgch487, urn:nbn:de:0183-14dgch4877

Veröffentlicht: 21. März 2014

© 2014 Frongia.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: The association between severe reactive airway disease (SRAD) and gastroesophageal reflux disease (GERD) is well described, while the causality has not been conclusively established. This study reports our experience with the effects of laparoscopic Thal fundoplication on the pulmonary status and medication of children with SRAD and GERD.

Material and methods: Between January 2006 and August 2012, 185 neurologically non-impaired children with medically refractory SRAD and GERD underwent laparoscopic Thal fundoplication. Clinical response, ability to wean oral and inhaled medication and changes in postoperative pulmonary function test are evaluated.

Results: Main preoperative respiratory symptoms were asthma (n=44; 23.8%), chronic cough (n=62; 33.5%), chronic airway infections (bronchitis/pneumonia, n=38; 20.5%) and others (n=41; 22.2%). Mean age at operation was 6,2±4.1 years; median study follow-up period was 3.6±1.8 years. Main respiratory symptoms were postoperatively significantly improved in n=165 (92.4%) patients, of which in n=125 (70.8%) patients symptoms completely disappeared. Inhalative steroids (n=127 patients) were successfully weaned off in n=89 (70.1%) and reduced in n=21 (16.5%) patients, while in n=17 (13.4%) patients mentioned medication was not reduced. Oral steroids (n=14 patients) were successfully weaned off in n=12 (85.7%) and reduced in n=2 (14.3%) patients. Inhalative beta-2-mimetics (n=85 patients) were successfully weaned off in n=60 (70.6%) and reduced in n=20 (23.5%), while in n=5 (0.6%) patients mentioned medication was not reduced. Proton pump inhibitors (n=111 patients) were discontinued in n=107 (96.4%), reduced in n=2 (0.2%) and further taken by n=2 (0.2%) patients. In the initial postoperative period pulmonary function test (n=102 patients) showed improvements in n=56 (53.8%) patients. There was one intraoperative complication (0.5%), a gastric perforation laparosopically managed without further complications. No conversion was necessary. In n=2 (1.0%) patients a postoperative Dumping Syndrome was managed successfully by dietary measures within 2 months; n=8 patients (4.3%) had dysphagia postoperatively, of which in n=7 cases dysphagia was spontaneously regressive within 4 weeks.

Conclusion: Children with SRAD and documented GERD refractory to medical management show improvement in their respiratory status after laparoscopic Thal fundoplication. Postoperatively many can be weaned off their oral and inhalative medication. We recomend laparoscopic Thal fundoplication in neurologically non-impaired children with medically refractory SRAD and GERD.