Cano Novillo I, Benavent Gordo M I, Portela Casalod E, Delgado Muñoz M D, Aguado Roncero P, Vilariño Mosquera A, Berchi García F J
Servicio de Cirugía Pediátrica, Hospital Doce de Octubre, Madrid.
Cir Pediatr. 2000 Jan;13(1):20-4.
Recurrent gastroesophageal reflux following fundoplication is a challenging problem, because it is usually refractory to medical treatment and a second, technically difficult, antireflux operation is required. Different factors that may contribute to surgery failure have been identified in children. We present 8 cases who underwent redofundoplication after failed procedures, from a total number of 96 patients operated on due to gastroesophageal reflux. Four patient's had their initial fundoplication performed at our institution. Six patients were neurologically impaired, six had chronic pulmonary disease, and two had esophageal atresia. The main presenting symptoms were recurrent vomiting (n = 8) and aspiration (n = 4). Gastroesophageal reflux was confirmed by barium swallow and endoscopy. Operative findings showed wrap breakdown in two cases, warp breakdown associated with hiatal hernia in five, wrap breakdown associated with paraesophageal hernia in two cases, and paraesophageal hernia with normal wrap in one. A second Nissen procedure were performed in five cases, whereas a Collis-Nissen gastroplasty was realized in three with a short esophagus. Six patients had a successful outcome remaining symptom free, one has severe disphagia, and one has recurrent vomiting. In our experience, patients with recurrent gastroesophageal reflux disease should undergo an antireflux procedure tailored to specific anatomic or functional abnormalities.
胃底折叠术后复发性胃食管反流是一个具有挑战性的问题，因为它通常对药物治疗无效，需要进行第二次技术难度较大的抗反流手术。已确定儿童中可能导致手术失败的不同因素。我们报告了96例因胃食管反流接受手术的患者中，8例在初次手术失败后接受再次胃底折叠术的病例。4例患者在我们机构进行了初次胃底折叠术。6例患者有神经功能障碍，6例有慢性肺部疾病，2例有食管闭锁。主要症状为反复呕吐（8例）和误吸（4例）。通过钡餐和内镜检查确诊为胃食管反流。手术发现2例出现包绕破裂，5例包绕破裂合并食管裂孔疝，2例包绕破裂合并食管旁疝，1例食管旁疝但包绕正常。5例行第二次nissen手术，3例食管短者行collis-nissen胃成形术。6例患者手术成功，症状消失，1例有严重吞咽困难，1例反复呕吐。根据我们的经验，复发性胃食管反流病患者应根据特定的解剖或功能异常进行针对性的抗反流手术。
