A prospective randomized double-blind study of gastroesophageal reflux surgery in pediatric-sized developmentally disabled patients: Nissen fundoplication versus angelchik prosthesis

Glenn R. Gourley, John R. Pellett, B. Ulysses K. Li, William N. Adkins

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

In order to compare the standard Nissen fun-doplication with the more recent Angelchik antireflux pros-thesis, 47 pediatric-sized, developmentally disabled patients were prospectively randomized to receive either of these gastroesophageal antireflux procedures. The two groups were comparable at the time of surgery with regard to age, weight, surface area, emesis, number of chest radiographs, medications, lower esophageal sphincter pressure, and number and duration of reflux episodes during standard acid reflux testing. The Angelchik group required significantly less anesthesia time than the Nissen group: 107.4 ± 22.6 min (mean ± SD) versus 156.5 ± 42.4 min (p < 0.001). There was no difference in length of postsurgical hospital stay. Six months after surgery, both groups showed improvement. There was no significant difference between the Angelchik and Nissen groups in mean subjective assessment score, increased weight gain, decreases in emesis, numbers of chest radiographs, hospital days, or medications, increased lower esophageal sphincter pressure, or decreased numbers and duration of reflux during acid reflux testing. Long-term follow-up of eight Angelchik and 10 Nissen patients 12-30 months postsurgery (Angelchik 11.6 ± 6.0 months, Nissen 21.9 ±5.0 months) demonstrated no significant difference in the percent of time the distal esophageal pH was below 4.0. Significant complications potentially related to the type of procedure developed in 1/21 patients in the Angelchik group and 1/17 patients in the Nissen group. We conclude that both procedures are usually effective for the surgical treatment of gastroesophageal reflux. Further study is indicated in order to establish the longterm superiority of one procedure.

Original languageEnglish (US)
Pages (from-to)52-61
Number of pages10
JournalJournal of pediatric gastroenterology and nutrition
Volume5
Issue number1
DOIs
StatePublished - Jan 1986

Keywords

  • Angelchik prothesis
  • Gastroesophageal reflux
  • Nissen fundoplication

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