Boix-Ochoa (Partial Fundoplication) Treats Reflux, Even in Neurologically Impaired Patients. Can it Take the Title of “Gold Standard” from Total Fundoplication?
- 153 Downloads
In 4–5% of cases of gastroesophageal reflux disease (GERD), surgical treatment is required. The aim of the study was to evaluate the success of Boix-Ochoa antireflux surgery, which is considered more physiologic with a higher failure rate (need for reoperation) than Nissen fundoplication, which is believed to be the gold standard operation.
In the 13 years from 2005 to 2018, the medical records of all children who underwent Boix-Ochoa in a single institution by pediatric surgeons were reviewed retrospectively.
A total of 133 fundoplications were performed, of which patients were divided into four groups: neurologically impaired, structurally impaired, neurologically and structurally impaired, and neurologically and structurally normal; there were 64, 8, 34, and 27 patients in each group, respectively. Structural impairments included hiatal hernia and esophagus atresia, having previously had a gastrostomy and esophageal stenosis. The most common short-term complication was distal esophageal stenosis (13%), which caused vomiting and dysphagia, and was treated by dilatations. There were six (4.5%) recurrences of GER, one in the neurologically and structurally impaired group with a hiatal hernia and five in the structurally impaired group (three esophagus atresias, two caustic esophageal strictures). The mean follow-up period was 5.27 ± 3.43 years. Neurological impairment did not affect the success rate.
Although there has not any literature demonstrating significant benefits of one procedure, we detected with this largest study in the pediatric literature about Boix-Ochoa fundoplication (more physiologic and easily performed) that it was successful (95%) in protecting reflux even in neurologically impaired patients (98%). We consider Boix-Ochoa (partial fundoplication) to be an alternative method to Nissen (complete fundoplication), and it can be done safely with a high success rate.
KeywordsFundoplication Children Gastroesophageal reflux disease Boix-Ochoa Partial fundoplication
- Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work;
- Drafting the work or revising it critically for important intellectual content;
- Final approval of the version to be published; and
- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
All authors meet all the four criteria mentioned above.
Compliance with Ethical Standards
The data review and collection were performed in compliance with the principles of the ethics committee and the Declaration of Helsinki. This study was approved by the Başkent University Ethical Committee.
- 2.Oldham K, Massey M: Antireflux surgery, in Stringer M (ed):Pediatric surgery and Urology: Long Term Outcomes, Philadelphia, PA, sounders, 1998, pp 189–213Google Scholar
- 8.Thatch KA, Yoo EY, Arthur LG 3rd, Finck C, Katz D, Moront M, et al. A comparison of laparoscopic and open Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit population. J Pediatr Surg. 2010; 45(2):346–9. doi: https://doi.org/10.1016/j.jpedsurg.2009.10.073. CrossRefPubMedGoogle Scholar
- 10.Boix-Ochoa J, Rowe M: Gastroesophageal reflux, in O’Neill J Jr, Rowe M, Grosfield JL, et al, (eds): Pediatric Surgery, Vol 1. St Louis, Mo, Mosby-Year Book, 1998, pp 1007–1017Google Scholar
- 11.Glen P, Chassé M, Doyle MA, Nasr A, Fergusson DA. Partial versus complete fundoplication for the correction of pediatric GERD: a systematic review and meta-analysis. PLoS One. 2014; 9(11):e112417. doi: https://doi.org/10.1371/journal.pone.0112417. eCollection 2014.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Nissen R, Rosetti M. Modern operations for hiatal hernia and reflux esophagitis: gastropexy and fundoplication. ArchivioChirTorace. 1959; 13:375–87.Google Scholar
- 13.Di Lorenzo C, Orenstein S. Fundoplication: friend or foe? J PediatrGastroenterolNutr. 2002; 34(2):117–24.Google Scholar
- 14.Esposito C, Montupet P, van Der Zee D, Settimi A, Paye-Jaouen A, Centonze A, et al. Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. SurgEndosc. 2006; 20(6):855–8.Google Scholar
- 15.Boix-Ochoa J: Gastroesophageal reflux. In Welch KJ, Randolph JG, Ravitch MM, O’Neill JA and Rowe MI (eds): Pediatric Surgery Chicago, Year Book Medical Publishers Inc., 1986, pp.712–720Google Scholar
- 16.Gilger MA, Yeh C, Chiang J, Dietrich C, Brandt ML, El-Serag HB. Outcomes of surgical fundoplication in children. ClinGastroenterolHepatol. 2004 ; 2(11):978–84.Google Scholar
- 18.Boix-Ochoa J, Marhuenda C: Gastroesophegeal reflux. In Ashcraft KW (ed): Pediatric Surgery, Philadelphia, WB. Sounders Company, 3rd edition, 2000, 370–389Google Scholar
- 21.Capito C, Leclair MD, Piloquet H, Plattner V, Heloury Y, Podevin G. Long-term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children. SurgEndosc. 2008; 22(4):875–80.Google Scholar