Hypoplastic Myenteric (Auerbach) Plexus of Small Intestine and Colon of Premature Infants with Bronchopulmonary Dysplasia Who Had Nissen Fundoplication for Gastroesophageal Reflux

Abstract

Gastroesophageal reflux (GER) is well documented in premature infants with bronchopulmonary dysplasia (BPD).^1–3 When medical management is inadequate or no longer effective in improving reflux, Nissen fundoplication is the therapy most often used.⁴ However, it has been our experience that these patients often continue to have gastrointestinal (GI) motility problems after surgery, and a variety of sequelae of fundoplication possibly related to abnormal intestinal motility, including persistent retching⁵ and dumping syndrome,^6,7 have been reported in such patients. Whether gastric overdistension severe enough to cause gastric or visceral infarction occurs in the absence of other causes of intestinal obstruction such as adhesions⁸ or volvulus⁹ in infants who have had fundoplication is not known. This study demonstrates by a microdissection flat-mount preparation technique the structural abnormalities of the MEP of the small intestine and colon of premature infants with BPD who had gastroesophageal reflux treated by Nissen fundoplication. The abnormalities may explain continuing gastrointestinal tract dysmotility in such patients.