Nissen vs. Toupet Fundoplication in the Treatment of Gastroesophageal Reflux Disease

Kelly L. Halbert, MSN, CPNP-AC

Disclosures

Pediatr Nurs. 2011;37(4):171-174. 

In This Article

Abstract and Introduction

Abstract

Gastroesophageal reflux disease (GERD) is a serious phenomenon in pediatric health care. Without proper treatment, complications related to GERD can impede normal development and can lead to multiple hospitalizations and medical conditions. Previously, surgical intervention was limited to one technique, nissen fundoplication; however, the use of various forms of fundoplication surgery, primarily the toupet fundoplication, is currently increasing. Nurses need to be aware of treatment options and care of pediatric patients with severe GERD requiring surgical intervention, including common treatment modalities used prior to surgery and postoperative care necessary to promote positive results following fundoplication surgery.

Introduction

Gastroesophageal reflux disease (GERD) is a growing phenomenon in pediatric patients that requires much attention. The prevalence of GERD in infants has been reported as high as 20% to 40% (Keady, 2007), with a higher prevalence in premature infants and infants with medical comorbidities (Riffe, Sayre, Waller, Brinker, & Roberts, 2007). Although most cases of infant GERD self-resolve by 1 year of age, if left untreated, GERD can lead to a number of complications, varying from esophagitis, dental erosion, otitis media, bronchitis, recurrent pneumonia, persistent asthma, and failure to thrive (Riffe et al., 2007). These complications can impede normal development and can lead to multiple hospitalizations and medical conditions involving chronic pulmonary and nutrition disorders, as well as dental problems and hearing loss. With better treatment of GERD, the rates and costs of hospitalizations associated with complications can decrease, and a better quality of life for patients and families dealing with GERD can be achieved.

Gastroesophageal reflux (GER) is defined as regurgitation of gastric contents into the esophagus (Riffe et al., 2007), whereas GERD is defined as symptoms or complications of GER (Horvath, Dziechciarz, & Szajewska, 2008). GERD most commonly presents in infancy between 1 to 4 months with symptoms of vomiting, poor weight gain, dysphagia, abdominal pain, irritability, and respiratory disorders (Horvath et al., 2008; Riffe et al., 2007). Depending on the severity of GERD, treatment options range from therapeutic lifestyle changes involving positioning, thickened feeds, and dietary changes, to medical management with the use of proton pump inhibitors or H2 blockers. The persistence of GERD, despite lifestyle and medical treatment or an inability to wean medication doses after optimization of medical management, enhances the likelihood of the patient requiring surgical intervention to achieve proper control of the symptoms associated with GERD. This article focuses on the outcomes associated with two fundoplication surgeries commonly used to treat GERD: nissen fundoplication (NF) and toupet fundoplication (TF).

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