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Outcomes of fundoplication: causes for concern, newer options
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  1. E Hassall
  1. Correspondence to:
    Dr E Hassall
    Professor of Pediatrics, Division of Pediatric Gastroenterology, BC Children’s Hospital/University of British Columbia, 4480 Oak St, Vancouver, BC V6H 3V4, Canada; ehassallcw.bc.ca

Abstract

Antireflux surgery has been a mainstay of treatment for gastro-oesophageal reflux disease in children for some 40 years. In recent years, enthusiasm for antireflux surgery seems only to have increased, despite its often poor outcome, and the availability of highly effective medical therapy in the form of proton pump inhibitors (PPIs). Reports show that many children undergo surgery without reflux disease as the demonstrable cause of their symptoms/signs, and without evidence of having failed optimised medical management. Very few studies report objective testing postoperatively—those that do show high rates of failure within the first 1–3 years following surgery. Treatment with PPIs is an effective and safe alternative to surgery in many cases.

  • GOR, gastro-oesophageal reflux
  • GORD, gastro-oesophageal reflux disease
  • H2RA, histamine-2 receptor antagonists
  • LNF, laparoscopic Nissen fundoplication
  • NI, neurological impairment
  • OA, oesophageal atresia
  • ONF, open Nissen fundoplication
  • PPI, proton pump inhibitor
  • gastro-oesophageal reflux disease
  • antireflux surgery
  • fundoplication
  • proton pump inhibitors
  • omeprazole
  • lansoprazole
  • adolescents

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Footnotes

  • * Compiled from references 1824, 26, 28, 29

  • Competing interests: E Hassall has received grant support from Astra-Zeneca in the past, and has served as a paid consultant to AstraZeneca and TAP Pharmaceutical Products Inc.

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