Current Surgical Role in Pediatric Gastroesophageal Reflux
Keywords:
Gastroesophageal reflux disease, Fundoplication, EsophagusAbstract
Reflux of gastric content into the esophagus is a physiologic event that mostly disappears with body growth. However, infants and children with gastroesophageal reflux may develop pathologic consequences, from esophagitis, failure to thrive to airway problems. Such gastroesophageal reflux with a pathologic consequence is known as a gastroesophageal reflux disease (GERD). Certain groups of pediatric patients, including children with neurological impairment, congenital esophageal malformation or congenital diaphragmatic hernia, have increased risk of GERD and these groups of patients have poorer response to non-surgical management. Wrapping the gastric fundus around the distal esophagus, fundoplication, is a surgical technique that has long been practiced to treat GERD. Although the procedure has been proven to support the shutter mechanism of the esophagogastric junction, it comes with potential complications such as swallowing difficulty, gas bloating syndrome or dumpling syndrome. Smart patient selection, detailed pre-operative evaluation, precise technical tailoring and post-operative follow-up are key success factors that a care team should develop when considering this procedure. In addition, frontier technologies, such as transoral endoscopic fundoplication, robotic-assisted fundoplication and magnetic bead esophageal supporting device, are on their way to this arena.
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