Gastro-oesophageal reflux in children: surgical management

Gastro-oesophageal reflux occurring infrequently and without symptoms or occurring without damage to the oesophagus is not considered pathological, otherwise the reflux and the pathology are referred to as gastro-oesophageal reflux disease (GORD). Factors predisposing to GORD include: impairments to the physiological antireflux barrier and anatomical abnormalities of the oesophagus or diaphragm. Non-operative and medical management result in resolution of symptoms in the majority of children. Surgery is indicated in the event of failure of medical management or severe complications and in neurologically normal children this would usually be a laparoscopic or open fundoplication. In severely neurologically impaired children other options are sometimes considered and these include: fundoplication with or without vagotomy and pyloroplasty; surgical feeding jejunostomy and oesophago-gastric dissociation.