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. 1974 Oct;180(4):479–485. doi: 10.1097/00000658-197410000-00013

Surgical Treatment of Gastroesophageal Reflux in Infants

Judson G Randolph, John R Lilly, Kathryn D Anderson
PMCID: PMC1344127  PMID: 4416000

Abstract

Thirty-one infants less than a year of age underwent surgery for correction of pernicious gastroesophageal reflux. Severe growth retardation from persistent vomiting was the single most important indication for surgery (25 patients). Recurrent aspiration penumonitis was another serious sequella of reflux and necessitated surgery in six patients. The diagnosis of gastroesophageal reflux was confirmed by barium swallow in all children, and in 17 a concomitant hiatal hernia was demonstrated. Patients selected for surgery were first treated conservatively unless they showed significant esophagitis or had a major portion of stomach in the chest. Babies treated early in the series had Allison repairs (7 transabdominal, 2 thoracic). Twenty-two subsequent patients have had Nissen fundoplication, and two gastropexies were performed. In 15 patients, significant gastric outlet obstruction required a complementary pyloroplasty. Four infants required a second surgical procedure because of recurrence. Two of the four patients had Nissen procedures with good results, one following a Boerema gastropexy and one following an Allison repair. The other two patients needed revision after fundoplication. There was no mortality. Twenty-eight children have been followed 6 months–8½ years. All have excellent nutritional status and are following normal growth curves. Study of these patients indicates the need for early diagnosis and medical or surgical therapy for all infants with major gastroesophageal reflux.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLISON P. R. Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet. 1951 Apr;92(4):419–431. [PubMed] [Google Scholar]
  2. BOEREMA I., GERMS R. Fixation of the lesser curvature of the stomach to the anterior abdominal wall after reposition of the hernia through the oesophageal hiatus. Arch Chir Neerl. 1955;7(4):351–359. [PubMed] [Google Scholar]
  3. BOIX-OCHOA J., REHBEIN F. OESOPHAGEAL STENOSIS DUE TO REFLUX OESPHAGITIS. Arch Dis Child. 1965 Apr;40:197–199. doi: 10.1136/adc.40.210.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. BURKE J. B. Partial thoracic stomach in childhood. Br Med J. 1959 Oct 24;2(5155):787–792. doi: 10.1136/bmj.2.5155.787. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bettex M., Kuffer F. Long-term results of fundoplication in hiatus hernia and cardio-esophageal chalasia in infants and children. Report of 112 consecutive cases. J Pediatr Surg. 1969 Oct;4(5):526–530. doi: 10.1016/0022-3468(69)90092-x. [DOI] [PubMed] [Google Scholar]
  6. CARRE I. J. Postural treatment of children with a partial thoracic stomach ('hiatus hernia'). Arch Dis Child. 1960 Dec;35:569–580. doi: 10.1136/adc.35.184.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. CARRE I. J. The natural history of the partial thoracic stomach (hiatus hernia) in children. Arch Dis Child. 1959 Aug;34:344–353. doi: 10.1136/adc.34.176.344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Carcassonne M., Bensoussan A., Aubert J. The management of gastroesophageal reflux in infants. J Pediatr Surg. 1973 Oct;8(5):575–586. doi: 10.1016/0022-3468(73)90394-1. [DOI] [PubMed] [Google Scholar]
  9. Cravioto J., Delicardie E. R. Mental performance in school age children. Findings after recovery from early severe malnutrition. Am J Dis Child. 1970 Nov;120(5):404–410. doi: 10.1001/archpedi.1970.02100100068004. [DOI] [PubMed] [Google Scholar]
  10. FILLER R. M., RANDOLPH J. G., GROSS R. E. ESOPHAGEAL HIATUS HERNIA IN INFANTS AND CHILDREN. J Thorac Cardiovasc Surg. 1964 May;47:551–565. [PubMed] [Google Scholar]
  11. Humphreys G. H., Wiedel P. D., Baker D. H., Berdon W. E. Esophageal hiatus hernia in infancy and childhood. Pediatrics. 1965 Sep;36(3):351–358. [PubMed] [Google Scholar]
  12. Kamal I., Guiney E. J. The treatment of hiatus hernia in children by anterior gastropexy. J Pediatr Surg. 1972 Dec;7(6):641–643. doi: 10.1016/0022-3468(72)90272-2. [DOI] [PubMed] [Google Scholar]
  13. Lilly J. R., LoPresti J., Randolph J. G. Hiatal hernia in infants. South Med J. 1967 May;60(5):545–548. doi: 10.1097/00007611-196705000-00021. [DOI] [PubMed] [Google Scholar]
  14. Lilly J. R., Randolph J. G. Hiatal hernia and gastroesophageal reflux in infants and children. J Thorac Cardiovasc Surg. 1968 Jan;55(1):42–54. [PubMed] [Google Scholar]
  15. McNamara J. J., Paulson D. L., Urschel H. C., Jr Hiatal hernia and gastroesophageal reflux in children. Pediatrics. 1969 Apr;43(4):527–532. [PubMed] [Google Scholar]
  16. NISSEN R., ROSSETTI M. SURGERY OF HIATAL AND OTHER DIAPHRAGMATIC HERNIAS. J Int Coll Surg. 1965 Jun;43:663–674. [PubMed] [Google Scholar]
  17. Randolph J. G. Pedicle pyloroplasty. J Pediatr Surg. 1971 Jun;6(3):388–392. doi: 10.1016/0022-3468(71)90483-0. [DOI] [PubMed] [Google Scholar]
  18. Rohatgi M., Shandling B., Stephens C. A. Hiatal hernia in infants and children: results of surgical treatment. Surgery. 1971 Mar;69(3):456–462. [PubMed] [Google Scholar]
  19. Vos A., Boerema I. Surgical treatment of gastroesophageal reflux in infants and children: long-term results in 28 cases. J Pediatr Surg. 1971 Apr;6(2):101–111. doi: 10.1016/0022-3468(71)90302-2. [DOI] [PubMed] [Google Scholar]

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