Gastroesophageal Reflux Surgery in Neonatal Pediatric Patients: A Review

Abstract

Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in newborns and children remain a significant cause of morbidity. Practice patterns and preferences among different institutions and among surgeons vary significantly. Controversial issues include the use of gastrostomy alone versus gastrostomy with Nissen fundoplication, laparoscopic versus open fundoplication, the role of the prophylactic Nissen fundoplication in newborns, Nissen fundoplication in neurologically intact versus neurologically impaired newborns, and the role as well as selection of investigations to evaluate the presence of gastroesophageal reflux in surgical decision making. A review of the recent literature as well as the senior author’s personal experience was used to evaluate the current state of GER surgery in the neonatal population. GER in newborns and young children is treated in various ways at different institutions and by different pediatric surgeons. The paucity of controlled studies of these diagnostic and treatment algorithms continues to be a source of controversy. There is general agreement that fundoplication is the preferred option in cases of severe refractory GER with comorbidities, especially when gastrostomy for feedings is indicated. Neurologically impaired children with GER benefit from antireflux surgery to prevent the complications of GERD. Risks and benefits of each treatment modality must be clearly explained to parents and caregivers early in the surgical decision-making process to ensure improved outcomes for these patients. Additional controlled studies are needed to further assess which practice patterns better serve this patient population.