Anterior fundoplication at the time of congenital diaphragmatic hernia repair
| Autor: | Clifford C. Marr, Steven T. Elliott, Stephen K. Greenholz, Yigit S. Guner |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Reflux Fundoplication Pediatrics Pediatric Surgery Neonate Pediatric surgery Medicine & Public Health Medicine Humans Pediatrics Perinatology and Child Health Hernia Diaphragmatic business.industry General surgery fungi Infant Newborn Congenital diaphragmatic hernia General Medicine medicine.disease Infant newborn digestive system diseases Surgery Medicine public health Pediatrics Perinatology and Child Health Gastroesophageal Reflux Original Article CDH business Hernias Diaphragmatic Congenital |
| Zdroj: | Guner, Yigit S.; Elliott, Steven; Marr, Clifford C.; & Greenholz, Stephen K.(2009). Anterior fundoplication at the time of congenital diaphragmatic hernia repair. Pediatric Surgery International, 25(8), pp 715-718. doi: 10.1007/s00383-009-2411-1. Retrieved from: http://www.escholarship.org/uc/item/77k3h7hq Pediatric Surgery International |
| Popis: | Purpose The loss of normal anatomic barriers in neonates with congenital diaphragmatic hernia (CDH) can predispose children to gastroesophageal reflux (GER). In an attempt to improve post-operative feeding, we have added a modified anterior fundoplication to restore natural gastric and esophageal positioning. Methods The institutional review board of both participating centers approved this study. Between 1997 and 2008, 13 neonates with high-risk anatomy underwent repair of CDH combined with an anterior fundoplication (Boix-Ochoa). The anatomic indications for concomitant fundoplication were absence of an intra-abdominal esophagus, an obtuse angle of His, and a small, vertically oriented stomach. Results Ten patients survived to discharge and eight were on full oral nourishment. One required partial gastrostomy feedings for an improving oral aversion and quickly progressed to full oral feedings. One patient with chromosomal anomalies and swallowing dysfunction remained on long-term bolus gastrostomy feedings. Two with progressive symptoms of GER and failure to thrive required conversion to a 360° wrap after 18 months of medical management. This was performed in conjunction with a planned, staged muscle flap reconstruction in one patient. There were no complications related to the fundoplication. Conclusion Anatomic predictors of severe GER can be efficiently countered at the time of CDH repair. A modified fundoplication should be considered in the operative management of high-risk infants. |
| Databáze: | OpenAIRE |
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