Treatment for Gastroesophageal Reflux in Children: Which Technique?

Gastroesophageal reflux (GER) is a common problem in infants and children. Pathologic gastroesophageal reflux disease (GERD) can develop during childhood. Pathologic GERD is the occurrence of reflux with associated complications that can include failure to thrive, aspiration, laryngospasm, and esophagitis. Neurologically impaired children show higher rates of GERD than neurologically normal children and may require treatment for GERD at the time of placement of a feeding tubeFundoplication is the surgical treatment of GERD and consists of a partial (less than 360 degrees) or complete wrap or plication (i.e. folding) of the fundus of the stomach around the esophagus. This surgery can be performed using either traditional open techniques or minimally invasive techniques. At present many different fundoplication techniques are used: patients are selected for surgery only if their medical treatment failed and if they show esophagitis and stricture or Barrett esophagus. Other indications to surgery are pulmonary symptoms, specifically asthma with persistent symptoms and reflux despite medical management and recurrent pneumonia associated with GER. At present there is not the gold standard technique but in the different cases reported in literature it is possible to identify some elements that may represent a “gold standard” for any type of fundoplication: crural closure, well mobilized esophagus, floppy wrap, and the use of non-absorbable sutures. The purpose of this review is to explain each technique from a strictly technical point of view and to report the clinical and surgical outcomes in the pediatric population.