Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice
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Read the article on jpedsurg.org ↗Article · Apr 2022 · 1 min read
In brief
In brief
Prospective French registry study of 762 CDH neonates examined preventive fundoplication practices during patch repair. Results showed significant practice variation across centers, with preventive fundoplication associated with higher overall fundoplication rates but unclear benefit for long-term GI outcomes including feeding difficulties and failure to thrive.
Written by the GCMD Library team from the article.
Introduction
Gastro-esophageal reflux disease (GERD) is the most frequent long-term morbidity of congenital diaphragmatic hernia (CDH) survivors. Performing a preventive fundoplication during CDH repair remains controversial. This study aimed to: 1) Analyze the variability in practices regarding preventive fundoplication; 2) Identify predictive factors for fundoplication.
3) Evaluate the impact of preventive fundoplication on gastro-intestinal outcomes in children with a CDH patch repair;
Methods
This prospective multi-institutional cohort study (French CDH Registry) included CDH neonates born in France between January 1st, 2010-December 31st, 2018. Patch CDH was defined as need for synthetic patch or muscle flap repair. Main outcome measures included need for curative fundoplication, tube feed supplementation, failure to thrive, and oral aversion.
Results
Of 762 CDH neonates included, 81 underwent fundoplication (10.6%), either preventive or curative. Median follow-up was 3.0 years (IQR: 1.0-5.0).
1) Preventive fundoplication is considered in only 31% of centers. The rates of both curative fundoplication (9% vs 3%, p=0.01) and overall fundoplication (20% vs 3%, p