Management of gastroesophageal reflux disease following esophageal atresia surgery: a systematic review.

Abstract

Gastroesophageal reflux disease (GERD) is a prevalent complication following esophageal atresia (EA) repair, with high recurrence rates and frequent treatment failures despite advancements in medical and surgical management. Effective intervention is crucial to prevent symptom relapse and long-term morbidity. This systematic review, conducted using PubMed, Scopus, and Web of Science with additional manual reference screening, included 33 studies encompassing 6,167 patients. 27 studies were retrospective cohort analyses evaluating anti-reflux surgery (ARS) outcomes and complications, while a few assessed GERD prevalence and risk factors influencing ARS success or failure. GERD prevalence in EA patients ranges from 25 to 80%, with uncertain long-term efficacy of medical therapy and dietary modifications. Fundoplication, previously performed routinely, is now selectively recommended following a multidisciplinary evaluation to differentiate GERD from alternative causes such as esophageal dysmotility, aspiration, or recurrent fistulas. Approximately 40% of EA patients require ARS, yet failure rates range from 7.8% to 47%. Identified risk factors for failure include male sex, prior abdominal surgery, long-gap EA, and congenital diaphragmatic hernia. Laparoscopic fundoplication, though increasingly adopted, has higher failure rates than open Nissen fundoplication in complex cases. Despite surgical intervention, GERD recurrence remains a concern, necessitating long-term surveillance. While open Nissen fundoplication remains the gold standard, persistent symptoms highlight the need for large-scale, randomized controlled trials to refine GERD management and optimize surgical decision-making in this high-risk population.