Tim Jancelewicz1, Monica E Lopez2, Cynthia D Downard3, Saleem Islam4, Robert Baird5, Shawn J Rangel6, Regan F Williams7, Meghan A Arnold8, Dave Lal9, Elizabeth Renaud10, Julia Grabowski11, Roshni Dasgupta12, Mary Austin13, Julia Shelton14, Danielle Cameron6, Adam B Goldin15. 1. Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap, Second Floor, Memphis, TN, 38105. Electronic address: tjancele@uthsc.edu. 2. Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. 3. Division of Pediatric Surgery, Hiram C. Polk, Jr., M.D. Department of Surgery, Program Director, Pediatric Surgery Fellowship, University of Louisville, Louisville, KY. 4. University of Florida, Gainesville, FL. 5. Department of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, QC. 6. Department of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA. 7. Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap, Second Floor, Memphis, TN, 38105. 8. CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI. 9. Division of Pediatric Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI. 10. Department of Surgery, Division of Pediatric Surgery, Albany Medical Center, Albany, NY. 11. Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL. 12. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, Cincinnati, OH. 13. Department of Pediatric Surgery, The University of Texas Medical School at Houston and in Surgical Oncology and Pediatrics at the UT M.D., Anderson Cancer Center, Houston, TX. 14. Division of Pediatric Surgery, University of Iowa Children's Hospital, Iowa City, IA. 15. Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA.
Abstract
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the surgical treatment of pediatric gastroesophageal reflux disease (GERD). METHODS: Five questions were addressed by searching the MEDLINE, Cochrane, Embase, Central, and National Guideline Clearinghouse databases using relevant search terms. Consensus recommendations were derived for each question based on the best available evidence. RESULTS: There was insufficient evidence to formulate recommendations for all questions. Fundoplication does not affect the rate of hospitalization for aspiration pneumonia, apnea, or reflux-related symptoms. Fundoplication is effective in reducing all parameters of esophageal acid exposure without altering esophageal motility. Laparoscopic fundoplication may be comparable to open fundoplication with regard to short-term clinical outcomes. Partial fundoplication and complete fundoplication are comparable in effectiveness for subjective control of GERD. Fundoplication may benefit GERD patients with asthma, but may not improve outcomes in patients with neurologic impairment or esophageal atresia. Overall GERD recurrence rates are likely below 20%. CONCLUSIONS: High-quality evidence is lacking regarding the surgical management of GERD in the pediatric population. Definitive conclusions regarding the effectiveness of fundoplication are limited by patient heterogeneity and lack of a standardized outcomes reporting framework. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly level 3-4).
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the surgical treatment of pediatric gastroesophageal reflux disease (GERD). METHODS: Five questions were addressed by searching the MEDLINE, Cochrane, Embase, Central, and National Guideline Clearinghouse databases using relevant search terms. Consensus recommendations were derived for each question based on the best available evidence. RESULTS: There was insufficient evidence to formulate recommendations for all questions. Fundoplication does not affect the rate of hospitalization for aspiration pneumonia, apnea, or reflux-related symptoms. Fundoplication is effective in reducing all parameters of esophageal acid exposure without altering esophageal motility. Laparoscopic fundoplication may be comparable to open fundoplication with regard to short-term clinical outcomes. Partial fundoplication and complete fundoplication are comparable in effectiveness for subjective control of GERD. Fundoplication may benefit GERDpatients with asthma, but may not improve outcomes in patients with neurologic impairment or esophageal atresia. Overall GERD recurrence rates are likely below 20%. CONCLUSIONS: High-quality evidence is lacking regarding the surgical management of GERD in the pediatric population. Definitive conclusions regarding the effectiveness of fundoplication are limited by patient heterogeneity and lack of a standardized outcomes reporting framework. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly level 3-4).
Authors: Anne M Stey; Charles D Vinocur; R Lawrence Moss; Bruce L Hall; Mark E Cohen; Kari Kraemer; Clifford Y Ko; Brian D Kenney; Loren Berman Journal: Surg Endosc Date: 2018-02-05 Impact factor: 4.584
Authors: Claire Duvallet; Kara Larson; Scott Snapper; Sonia Iosim; Ann Lee; Katherine Freer; Kara May; Eric Alm; Rachel Rosen Journal: PLoS One Date: 2019-05-20 Impact factor: 3.240