Department of Pediatric Surgery, Caen University Hospital, Université de Caen Normandie, UFR Médecine, Avenue de La Côte de Nacre, F-14000, Caen, France.
Department of Pediatric Gastroenterology, Caen University Hospital, Université de Caen Normandie, UFR Médecine, F-14000, Caen, France.
Eur J Pediatr. 2023 May;182(5):2005-2012. doi: 10.1007/s00431-023-04897-2. Epub 2023 Mar 6.
The purpose of this study is to assess quality of life (QoL) after laparoscopic anti-reflux surgery (LARS) in children with gastroesophageal reflux disease (GERD) and to evaluate GERD symptoms and their impact on daily life and school. From June 2016 to June 2019, all children with GERD from 2 to 16 years of age, without neurologic impairment or malformation-related reflux, were prospectively included in a monocentric study. Patients (or their parents according to the age of the child) answered the Pediatric Questionnaire on Gastroesophageal Symptoms and QoL (PGSQ) before surgery and 3 and 12 months after surgery. Variables were compared by paired, bilateral Student t-test. Twenty-eight children (16 boys) were included. The median age at surgery was 77 months (IQR: 59.2-137) with median weight of 22 kg (IQR: 19.8-42.3). All had a laparoscopic Toupet fundoplication. Median duration of follow-up was 14.7 months (IQR: 12.3-22.5). One patient (4%) had a recurrence of GERD symptoms without abnormalities on follow-up examinations. Preoperative total PGSQ score was 1.42 (± 0.7) and decreased significantly 3 months (0.56 ± 0.6; p < 0.001) and 12 months after surgery (0.34 ± 0.4; p < 0.001). PGSQ subscale analysis revealed a significant decrease at 3 and 12 months for GERD symptoms (p < 0.001), impact on daily life (p < 0.001), and impact on school (p = 0.03).
There was a significant improvement in symptoms and their frequency after LARS in children, as well as an improvement of QoL, in the short and medium term. The impact of GERD should be taken into consideration in the treatment decision, given that surgery clearly improves the QoL.
• Laparoscopic anti-reflux surgery (LARS) is an established and effective treatment option in pediatric patients with severe GERD refractory to medical treatment. • Effect of LARS on the quality of life (QoL) has been mainly investigated in the adult population but there is very little data on the effect of LARS on the QoL in pediatric patients.
• Our prospective study was the first to analyze the effect of LARS on QoL in pediatric patients without neurologic impairment using validated questionnaires at two postoperative time points with a significant improvement in postoperative QoL at 3 and 12 months. • Our study emphasizes the importance of evaluating QoL and impact of GERD on all the aspects of daily life and of taking these into consideration in the treatment decision.
本研究旨在评估腹腔镜抗反流手术（LARS）治疗儿童胃食管反流病（GERD）后的生活质量（QoL），并评估 GERD 症状及其对日常生活和学校的影响。
从 2016 年 6 月至 2019 年 6 月，所有年龄在 2 至 16 岁、无神经损伤或与畸形相关反流的 GERD 患儿前瞻性纳入单中心研究。患者（或根据患儿年龄由其父母）在手术前和手术后 3 个月和 12 个月回答小儿胃食管症状和 QoL 问卷（PGSQ）。采用配对、双侧学生 t 检验比较变量。
共纳入 28 例患儿（16 例男孩）。手术时的中位年龄为 77 个月（IQR：59.2-137），中位体重为 22kg（IQR：19.8-42.3）。所有患儿均行腹腔镜 Toupet 胃底折叠术。中位随访时间为 14.7 个月（IQR：12.3-22.5）。1 例患儿（4%）出现 GERD 症状复发，但随访检查未见异常。术前总 PGSQ 评分为 1.42（±0.7），术后 3 个月（0.56±0.6；p<0.001）和 12 个月（0.34±0.4；p<0.001）显著下降。PGSQ 亚量表分析显示，术后 3 个月和 12 个月时 GERD 症状（p<0.001）、日常生活影响（p<0.001）和学校影响（p=0.03）均显著下降。
在儿童中，LARS 后症状及其频率有明显改善，短期和中期 QoL 也有改善。鉴于手术明显改善 QoL，GERD 的影响应在治疗决策中考虑。
•腹腔镜抗反流手术（LARS）是一种已确立且有效的治疗方法，适用于对药物治疗无效的严重 GERD 患儿。•LARS 对生活质量（QoL）的影响主要在成人人群中进行了研究，但关于 LARS 对儿科患者 QoL 的影响的数据很少。
•我们的前瞻性研究首次使用验证后的问卷分析了神经损伤儿童 LARS 对 QoL 的影响，在术后两个时间点，QoL 有显著改善，术后 3 个月和 12 个月时 QoL 有显著改善。•我们的研究强调了评估 QoL 和 GERD 对日常生活各个方面的影响，并在治疗决策中考虑这些因素的重要性。
