Surgical management of gastro-oesophageal reflux in children

Gastro-oesophageal reflux (GOR) in newborns does not necessarily represent a clinical disease, but rather a somewhat delayed physiological development that corrects with time. Gastro-oesophageal reflux disease (GORD) is defined as secondary symptoms and complications arising from gastro-oesophageal reflux. GORD requires aggressive medical management in an attempt to reverse complications and hopefully achieve long-term cure. Supportive or medical treatment is sufficient in mild cases, but GORD is best managed surgically when severe disease or complications are present. Investigations to support the diagnosis and assess the severity usually include: upper gastrointestinal endoscopy, pH study and upper gastrointestinal contrast study. A combined pH and impedance study may become the gold standard investigative tool with increased experience in children. Surgical procedures for GORD aims to augment or correct some of the mechanisms which prevent GOR. The Nissen fundoplication is the most frequently performed operation, but several other fundoplications are also used. Symptom control can be achieved with improvement in quality of life, but recurrence rates can be high in patients with neurological impairment or generalized bowel dysmotility.