Acid Reflux Research Today is a free monthly online journal that collates and summarizes the latest research about Acid Reflux, including details on diet, gerd (gastro-esophageal reflux disease), treatment, symptoms.

A reinforced suture line prevents recurrence after fundoplication in patients with familial dysautonomia.

Nadler EP, Leung S, Axelrod FB, Ginsburg HB

Division of Pediatric Surgery, Department of Surgery, New York University School of Medicine, New York, NY 10016, USA. evan.nadler@med.nyu.edu

BACKGROUND/PURPOSE: Long-term follow-up of fundoplication in patients with familial dysautonomia (FD) has revealed a high rate of recurrent gastroesophageal reflux. This may be because of the unique characteristics of patients with FD which include autonomic denervation accompanied by cyclic vomiting and retching. We reviewed our results with adaptations to the Nissen fundoplication to determine which would be most effective in preventing the need for reoperation. METHODS: We reviewed the records of 108 patient with FD who underwent fundoplication by a single pediatric surgeon from November 1978 to July 1, 2004. Patients were divided into 4 groups based on the operative technique: standard Nissen fundoplication, Nissen with a posterior gastropexy, Nissen with posterior gastropexy and a superior anchoring suture, and Nissen with a reinforced suture line in addition to the previous modifications. Demographic data and surgical outcomes were abstracted. RESULTS: Patients who underwent a Nissen fundoplication with a reinforced suture line were significantly less likely to require a reoperation for recurrent reflux than any other patients (P = .05, Fisher's Exact test) despite the fact that they were younger than patients who underwent a standard Nissen alone. CONCLUSION: The addition of a reinforced suture line to the standard Nissen fundoplication decreases the failure rate for patients with gastroesophageal reflux and FD. A reinforced suture line may be an attractive modification for patients where the fundoplication may be under continued physical stress caused by autonomic perturbations, or other conditions such as uncontrolled seizures or progressive neurologic decline.

Published 23 April 2007 in J Pediatr Surg, 42(4): 653-6.
Full-text of this article is available online (may require subscription).

© 2004-2008 Acid Reflux Research Today. All Rights Reserved.