Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice
Topic overview
Prospective French cohort study (762 CDH neonates, 2010-2018) examining preventive fundoplication practices during CDH repair. Patch repair was the only independent predictor of requiring curative fundoplication, while preventive fundoplication did not reduce need for later surgery or improve feeding outcomes in patch CDH patients.
Key takeaways
- Preventive fundoplication during CDH patch repair does not reduce the need for later curative fundoplication (15% vs 11%, p=0.53).
- Preventive fundoplication is associated with worse outcomes: higher rates of failure to thrive, prolonged tube feeding, and oral aversion.
- Patch repair is the only independent predictor for requiring curative fundoplication after CDH repair (median age 101 days).
- Centers performing preventive fundoplication have higher overall fundoplication rates (20% vs 3%), suggesting practice variation drives outcomes.
- Only 8% of CDH patients required curative fundoplication, questioning the benefit of routine preventive surgery in this population.
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