Long-term Efficacy of Pediatric Anti-reflux Surgery in Reduction of Acid-reducing Medication
Author Department
Surgery; Pediatrics
Document Type
Article, Peer-reviewed
Publication Date
5-2025
Abstract
Introduction: Revision of anti-reflux procedures (ARPs) has contributed to a shift away from surgical management of pediatric gastroesophageal reflux disease. Long-term proton-pump inhibitor and H2 antagonist use, however, is associated with infection and micronutrient malabsorption. This study investigates long-term ARP efficacy in decreasing acid-reduction medication (ARMs) usage.
Methods: A retrospective cohort study of pediatric patients undergoing ARP at a single institution was conducted from January 1, 2000 to December 31, 2017, allowing for at least a 6-y follow-up. Eligibility included patients less than 18 y undergoing index ARP. Age, weight, comorbidities, and ARM use were collected. Operative information included procedure type and hospital course. Postoperative information included complications, reoperation, postoperative symptoms, and postoperative ARMs. t-Tests compared continuous outcomes, while chi-square test compared frequency of categorical outcomes.
Results: In total, 305 patients were included with a mean (standard deviation) age of 7.2 (6.5) y. In total, 54.7% of patients were male; 70.7% were White, 23% Hispanic, and 5.7% Black. The procedure was laparoscopic for 99.3% and open for 0.7% (n = 2). The most common preoperative symptoms were regurgitation (53.4%) and retrosternal pain (9.2%). Postoperatively, regurgitation remained the most common at 30.8% (n = 94). The most common comorbidities were neurodevelopmental delay (42%, n = 128) and asthma (35.7%, n = 109). 11.8% (n = 33) underwent reoperation. Subsequently, 2.4% (n = 7) of the patients were within 90 d of operation, most commonly for wrap slippage (n = 11) or hiatal hernia (n = 9). AMRs were discontinued in 39.8% (n = 80) of the patients within 30 d and 57.4% (n = 156) at most recent follow-up. It appeared most efficacious for neurodevelopmental delay patients. The mean follow-up was 10 y.
Conclusions: More than half of the patients discontinued ARMs following ARP suggesting that surgery remains beneficial in reducing long-term medication use.
Keywords: Anti-reflux surgery; Fundoplication; Gastroesophageal reflux; Histamine antagonist; Laparoscopic surgery; Pediatric; Proton pump inhibitor.
Recommended Citation
Rosenberg M, Perez Coulter A, Pepper V, Banever G, Tashjian D, Moriarty K, Tirabassi MV. Long-term Efficacy of Pediatric Anti-reflux Surgery in Reduction of Acid-reducing Medication. J Surg Res. 2025 May 24;311:112-117. doi: 10.1016/j.jss.2025.04.020. Epub ahead of print.
PMID
40414153