gms | German Medical Science

Background: The purpose of the study was to identify influential factors contributing to the variation with which fundoplications are indicated and performed in children with chronic airway diseases (CAD) and gastroesophageal reflux disease (GERD).

Materials and methods: European-wide online survey among European pediatric surgeons (22 items), including the subjective value of different diagnostics (score 0=low to 10=high) for indication setting. Evaluation was stratified in northern, middle and southern countries.

Results: Thirty percent (n=56) of contacted surgeons responded so far. Given a GERD is verified, most (93.3%) reported that the indication for FP is strengthen with the presence of CAD symptoms, while about half (46.8%) reported this in case of CAD symptoms improvement on proton pump inhibitors therapy. The most valuable GERD-evaluation tools for children with CAD are considered the prolonged esophageal ph-metry, impedance study and esophagogastroscopy (7.4±0.4 / 7.2±0.5 / 6.9±0.5). A fundoplicatio is offered by 66.0% in justified exceptional cases of obvious GERD symptoms, however normal or uncertain diagnostic. The diagnostic evalutation, indication setting for FP and technical approach did not differ significantly between north, middle and south Europe (p>0.05).

Conclusion: These data suggest that among European pediatric surgeons FP is given widespread consideration in the treatment of children with CAD and GERD. However, the surgeons indication to FP may be also influenced by subjective factors in case of inconclusive studies. Our survey reinforces the need for further examination of specific factors in preoperative decision making for FP in the pediatric population with CAD.