The value of 24-h pH study in evaluating the results of laparoscopic antireflux surgery in children.

BACKGROUND: The performance of laparoscopic antireflux surgery is steadily increasing among pediatric surgeons. Different techniques are being used. However, due to a lack of standardized follow-up methods, postoperative results are difficult to compare. In this study, we describe the results of postoperative 24-h pH study as an objective criterion for evaluating the results of laparoscopic Thal antireflux surgery.
METHODS: In a prospective study, 53 patients underwent a laparoscopic Thal procedure. Preoperatively, all patients were subjected to 24-h pH monitoring, an upper GI series, and esophagogastroscopy. pH monitoring was performed 3 months postoperatively to evaluate the effect of the fundoplication. Esophagogastroscopy was repeated in case of preoperative esophagitis.
RESULTS: In one patient, the laparoscopy was converted to an open procedure. Feeding was commenced on day 1 in 49 of the 53 children. Mean hospitalization time was 4.4 days. One patient was reoperated for a too-tight fundoplication, and two patients died of unrelated causes. Ultimately, 44 of 50 children (88%) were free of symptoms; however, 11 of 41 children (25%) still displayed pathological reflux on pH monitoring.
CONCLUSIONS: The Thal fundoplication can be performed laparoscopically in children. Children have a quick recovery, and hospitalization is short (4.4 days). At follow-up, nearly 90% of the children are free of symptoms. However, 25% still have pathological reflux as measured with pH monitoring. Therefore, questionnaires alone are not a sufficient means of measuring outcome postoperative. pH monitoring is a valuable additional tool for the objective postoperative evaluation of the results of (laparoscopic) antireflux procedures.