Surgical treatment of the gastroesophageal reflux syndrome in childhood.

During the past 16 years 290 children under 18 years of age underwent gastroesophageal fundoplication (GEF) at the UCLA Medical Center for treatment of symptomatic reflux (GER) which was refractory to medical therapy. CNS disorders requiring feeding gastrostomies were the indication for GEF in 35 percent of children. Approximately 50 percent of children evaluated for symptomatic GER during the past five years had delayed gastric emptying as determined in slow egress of 99mTC sulfur colloid mixed in semi-solid foods. Children who retain more than 50 percent of the isotope feedings after 90 minutes should have a pyloroplasty in addition to GEF (18 children). Children with delayed gastric emptying and a high normal LESP may benefit from pyloroplasty alone (14 patients). Since over 30 percent of children with GER have esophageal dysmotility, emphasis is placed on constructing a loose GEF. Reflux symptoms were relieved in all 304 operated children.