ORLANDO — Laparoscopic Nissen fundoplication was able to maintain or improve pulmonary function in 14 children with severe gastroesophageal reflux disease and cystic fibrosis, Dr. Sean J. Barnett and his associates reported in a poster at the annual meeting of the American Pediatric Surgical Association.
Children with cystic fibrosis usually have an average 1% per year drop in their pulmonary function. The new findings, based on a single-center review, showed that laparoscopic Nissen fundoplication not only was safe but also stabilized pulmonary function in these children.
The study retrospectively reviewed all 75 children who underwent the procedure for severe gastroesophageal reflux disease at the University of Minnesota in Minneapolis during February 2002-October 2006. The group included 14 children with a definitive diagnosis of cystic fibrosis based on a sweat chloride test. Their reflux disease was documented by esophageal pH testing. The average age of the 14 patients (six girls and eight boys) was 10.7 years, with ages ranging from 5 to 16 years.
The surgery was done on an elective basis in all 14 patients. The average follow-up was 48 months, and 11 of the patients had follow-up of more than 1 year; 3 patients had follow-up of more than 4 years.
Pulmonary function was assessed preoperatively and then at 1 month and at 1, 2, 3, and 4 years after surgery. Pulmonary function was measured for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and as the ratio of FEV1:FVC. The 14 patients showed a significant rise in their average FVC and FEV1, reported Dr. Barnett, who is now a pediatric surgeon at Cincinnati Children's Hospital. The FEV1:FVC ratio also showed an increase over time, but the rise was not statistically significant.