Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice
Topic overview
Prospective French cohort study of 762 CDH neonates examines the controversial practice of preventive fundoplication during diaphragmatic hernia repair. Results show preventive fundoplication does not reduce need for later curative surgery and is associated with higher rates of failure to thrive in patch repair cases.
Key takeaways
- Only 8% of CDH patients required curative fundoplication; patch repair was the sole independent predictor on multivariate analysis.
- Preventive fundoplication during CDH patch repair did not reduce need for later curative fundoplication (15% vs 11%, p=0.53).
- Preventive fundoplication was associated with worse outcomes: higher rates of failure to thrive, prolonged tube feeds, and oral aversion.
- Centers performing preventive fundoplication had higher overall fundoplication rates (20% vs 3%), suggesting practice variation drives intervention.
- In patch CDH repair, a selective approach to fundoplication appears preferable to routine preventive surgery given lack of benefit and worse feeding outcomes.
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