The effects of laparoscopic Nissen fundoplication on patients with severe gastroesophageal reflux disease and steroid-dependent asthma

J Pediatr Surg. 2012 Jun;47(6):1101-4. doi: 10.1016/j.jpedsurg.2012.03.013.

Abstract

Background: An association between severe reactive airway disease (RAD) and gastroesophageal reflux disease (GERD) in children has been previously noted, but the relationship has not been well characterized. This study reports our experience with laparoscopic Nissen fundoplication and its effect on the pulmonary status of children with severe steroid-dependent RAD.

Methods: Between January 1993 and June 2011, 235 patients with severe steroid-dependent RAD and medically refractory GERD underwent laparoscopic Nissen fundoplication. Clinical response, ability to wean oral and inhaled steroids, and changes in pulmonary function testing were tracked during the postoperative period.

Results: Of 235 patients, 215 (91%) noted significant subjective improvement in their respiratory symptoms by the first postoperative visit at 2 weeks. Eighty percent was successfully weaned off their oral steroids within the first 2 postoperative months. Ninety-five percent reported a decrease in their inhaler use. Twenty-four percent of patients studied had a documented increase in their forced expiratory volume in the initial postoperative period. There were no intraoperative complications and no postoperative respiratory tract infections.

Conclusion: Children with steroid-dependent RAD and documented GERD refractory to medical management show improvement in their respiratory status after laparoscopic Nissen fundoplication. Many can be weaned off of their oral and inhaled steroids postoperatively.

MeSH terms

  • Adolescent
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy
  • Asthma / etiology*
  • Asthma / pathology
  • Bronchoalveolar Lavage Fluid
  • Child
  • Child, Preschool
  • Female
  • Forced Expiratory Volume
  • Fundoplication* / methods
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Laparoscopy* / methods
  • Lipids / analysis
  • Macrophages / chemistry
  • Male
  • Postoperative Period
  • Prednisone / administration & dosage
  • Prednisone / therapeutic use
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Asthmatic Agents
  • Lipids
  • Prednisone