Aim of the study:
To ascertain the management and outcomes of patients with gastro-oesophageal reflux (GOR) that require further intervention following failure of Nissen’s fundoplication (NF).
Retrospective review of paediatric patients who had further intervention following failure of primary NF 2006-2015 for GOR at a single centre. Data is presented as median (range). This study was registered with our audit department.
Of 820 patients who underwent NF, 123 (15%) required further procedures for GOR management. 81/123 (66%) patients had co-morbidities namely neurological impairment (48), congenital heart disease (17) and oesophageal atresia (16). All went on to have a second NF after 16 months (10 - 71). 23/123 (19%) had jejunal feeding via a gastrojejunal tube (GJ) between these two NFs. Following the second NF no further intervention was required in 80/123 (65%) (follow up of 48 months (12 - 58)). Further intervention for GOR was performed in 43/123 (35%) patients.
Of these, 7/43 (16%) proceeded straight to a third NF and 36/43 (84%) were managed with GJ.
GJ following a second NF was successful in 31/36 (86%) (follow up of 20 months (18 - 30)). 5/36 (14%) patients who had GJ following a failed second NF had a third NF. Overall interval between second and third NF was 19 months (15 - 24). Of the 12 patients who had a third NF it was clinically successful in 7 (58%). Patients who were finally successfully managed with GJ underwent 2 (2-5) tube changes/year.
Further intervention was required in 15 % and 100% of patients undergoing a first NF or second NF respectively. The vast majority of patients requiring further intervention after second NF are successfully managed by GJ, however this is a retrospective study and randomised study is required.