Fundoplication for Pediatric Gastroesophageal Reflux Disease (GERD): Indications, Techniques, and Outcomes

Abstract Purpose: This study aimed to evaluate the indications, techniques, and outcomes of fundoplication in pediatric patients with gastroesophageal reflux disease (GERD) at a tertiary hospital in Yemen. Patients and Methods: This prospective cohort study was conducted at Al-Thawra Modern General Hospital, Sana’a, Yemen, between January 2015 and January 2022. The study included 45 pediatric patients under 18 years who underwent fundoplication for GERD. Data on demographic and clinical characteristics, surgical type, postoperative complications, and follow-up outcomes were collected and analyzed.. Results: The median age of the 45 pediatric patients was 2 years (range: 2 months to 10 years), with 56% males and 44% females. The primary indications for fundoplication included GERD with hiatal hernia (44.4%), persistent symptoms despite medical management (20%), recurrent chest infections associated with neurological disorders (15.6%), esophageal stricture (17.8%), and both hiatal hernia and esophageal stricture (2.2%). Nissen fundoplication was performed in 80% of patients, while Thal fundoplication was performed in 20%. Complete symptom resolution was achieved in 68.89% of patients. Dysphagia due to postoperative esophageal stricture was the most common complication, affecting 29% of patients. A structured dilatation protocol resulted in 30.8% improvement after a single session, 46.2% after regular sessions, and 23.1% after irregular sessions. The mortality rate was 5.56%, with two deaths occurring in patients with cerebral palsy due to recurrent chest infections unrelated to GERD recurrence or esophageal stricture. Conclusion: Fundoplication is a safe and effective surgical treatment for pediatric GERD, with a high success rate and manageable complication rate. A structured postoperative dilatation protocol is essential for managing esophageal strictures and improving outcomes. Early diagnosis and intervention, along with adherence to postoperative protocols, are crucial for optimal results. Further research with larger sample sizes and long-term follow-up is recommended to confirm these findings and improve clinical practice.