Current issues of gastro-oesophageal reflux disease surgical treatment in children

Abstract

Gastro-oesophageal reflux (GER) disease is one of the most common diseases amongst a wide range of chronic inflammatory diseases of the gastrointestinal tract in children of all ages, significantly impairing the quality of life of the child and posing a serious threat to the health of the patient. From 2008 to 2019, 134 patients aging from 6 months to 12 years were hospitalised at the Scientific Center for Pediatrics and Pediatric Surgery including 69 (51%) infants. Of them, 51 (38%) were the patients with persistent manifestations of regurgitation, despite an outpatient course of conservative therapy; 29 (22%) patients with recurrent reflux-associated pneumonia; also, 35 (26%) children with GER in the structure of the main pathology of the central nervous system, as well as 19 (14%) patients after surgery of the anastomosis of the oesophagus with its atresia. One hundred and seven (79.8%) patients underwent surgery. Nissen oesophagofundoplication was traditionally performed in 41 (38%) patients, in combination with Stamm gastrostomy in 14 (34%), with Mikulich pyloroplasty in 9 (22%) and in combination with gastrostomy and pyloroplasty in 12 (29%) children. Laparoscopic Nissen oesophagofundoplication was used in 16 (15%) cases. Thall oesophagofundoplication was performed in 48 (45%) patients, while in two (2%) cases, Boerema gastropexy was conducted. The immediate results were studied in all 107 patients. Complications in the form of gastric distress syndrome were revealed in four (3.7%) patients who did not undergo pyloroplasty, which in two (1.9%) cases required additional surgery of the stomach draining, whereas in the other two (1.9%) patients, the distress syndrome was stopped conservatively. A dumping syndrome was identified in two (1.9%) patients. Timely recognition of the pathological process, its nature and prevalence determines the indications for the use of various methods of operation, which are based on an individual approach to each patient.

Keywords: Children; gastro-oesophageal reflux; oesophagitis; oesophagofundoplication.

Figure 1

Erosive oesophagitis fibroesophagoscopy: (a) Expansion of the cardiac outlet zone (b) Traces of erosion

Figure 2

Peptic stricture of the oesophagus. Fibroesophagoscopy: (a) Zone of peptic constriction at the level of the lower/third of the oesophagus; (b) erosive and ulcerative oesophagitis

Figure 3

Oesophagography: (a) expansion of the lumen of the lower/ third of the oesophagus; (b) change of his angle (110°)

Figure 4

Oesophagography: (a) zone of peptic narrowing of the middle/ third of the oesophagus; (b) expansion of the lumen of the lower/third of the oesophagus; (c) change of his angle (110°)

Figure 5

Algorithm for choosing the method of oesophagofundoplication

Figure 6

Algorithm for diagnostic research of children with regurgitations