Persistent Dysphagia Rate After Antireflux Surgery is Similar for Nissen Fundoplication and Partial Fundoplication.

BACKGROUND: Laparoscopic fundoplication is the gold standard operation for treatment of gastroesophageal reflux disease (GERD). It has been suggested that persistent postoperative dysphagia is increased following Nissen fundoplication compared to partial fundoplication. This study aimed to determine risk factors for persistent postoperative dysphagia, specifically examining the type of fundoplication. METHODS: Patients experiencing GERD symptoms who underwent laparoscopic Nissen, Toupet, or Dor fundoplication from 2009 to 2016 were identified from a single-institutional database. A dysphagia score was obtained as part of the GERD health-related quality of life questionnaire. Persistent dysphagia was defined as a difficulty swallowing score ≥1 (noticeable) on a scale from 0 to 5 at least 1 y postoperatively. Odds ratios of persistent dysphagia among those who underwent antireflux surgery were calculated in a multivariate logistic regression model adjusted for fundoplication type, sex, age, body mass index, and redo operation. RESULTS: Of the 441 patients who met inclusion criteria, 255 had ≥1 y of follow-up (57.8%). The median duration of follow-up was 3 y. In this cohort, 45.1% of patients underwent Nissen fundoplication and 54.9% underwent partial fundoplication. Persistent postoperative dysphagia was present in 25.9% (n = 66) of patients. On adjusted analysis, there was no statistically significant association between the type of fundoplication (Nissen versus partial) and the likelihood of postoperative dysphagia. CONCLUSIONS: Persistent postoperative dysphagia after antireflux surgery occurred in approximately one-quarter of patients and did not differ by the type of fundoplication. These findings suggest that both Nissen and partial fundoplication are reasonable choices for an antireflux operation for properly selected patients.

Latina/o Children Living With an Immigrant Mother With Depression: Developmental and Cultural Nuances in Recognition and Coping.

The psychological experience of maternal depression and its impact on immigrant Latina/o families often goes unrecognized and unaddressed. Children may feel especially helpless and confused about the changes they observe in their mothers' mood and behavior, and about the deterioration of family relationships. Given the interdependence of family structures of immigrant Latina/o households, maternal depression can be detrimental to Latina/o youth attributions and coping strategies, and to their relationship with their mothers. The quantitative focus of most research on maternal depression in Latina/o samples limits our understanding of family processes in maternal depression. The current qualitative study explores the perceived impact of maternal depression on Latina/o youths' attributions and coping strategies. This inquiry involved focus groups with 12 participants aged 9-16 years to explore their perspectives on maternal depression. All youth had participated in a 12-week multifamily group intervention focused on building family and cultural strengths to address maternal depression on immigrant Latina/o families. Findings of the focus groups illuminated the essential experience of youth living with maternal depression, and indicated that there are developmental considerations for how youth recognize and make meaning of maternal depression, and cope with disrupted family life. Additionally, youth reported engaging in these culture-specific ways of coping: using close sibling relationships and family structure as support, having fathers and extended family members engage in additional and restorative parenting practices, and participating in religious practices to seek refuge from family stress. We propose considerations for intervention and further areas of research.

La experiencia psicológica de la depresión materna y su efecto en las familias de inmigrantes latinos generalmente no se reconoce ni se trata. Los niños pueden sentirse especialmente desamparados y confundidos con respecto a los cambios que observan en el estado de ánimo y la conducta de sus madres, y con respecto al deterioro de las relaciones familiares. Dada la interdependencia de las estructuras familiares de los hogares de los inmigrantes latinos, la depresión materna puede ser perjudicial para las estrategias de adaptación y las atribuciones de los jóvenes latinos así como para sus relaciones con sus madres. El enfoque cuantitativo de la mayoría de las investigaciones sobre depresión materna en muestras de latinos limita nuestra comprensión de los procesos familiares en la depresión materna. El presente estudio cualitativo analiza el efecto percibido de la depresión materna en las estrategias de adaptación y las atribuciones de los jóvenes latinos. Esta investigación consistió en grupos focales con 12 participantes de entre 9 y 16 años para analizar sus perspectivas sobre la depresión materna. Todos los jóvenes habían participado en una intervención grupal multifamiliar de 12 semanas centrada en el refuerzo de los puntos fuertes familiares y culturales para abordar la depresión materna en las familias de inmigrantes latinos. Los resultados de los grupos focales aclararon la experiencia fundamental de los jóvenes que viven con depresión materna e indicaron que existen consideraciones del desarrollo en cuanto a cómo los jóvenes reconocen y entienden la depresión materna, y hacen frente a una vida familiar perturbada. Además, los jóvenes informaron que recurrieron a estas formas de afrontamiento propias de su cultura: usaron como apoyo las relaciones estrechas entre hermanos y la estructura familiar, pidieron a los padres y a parientes lejanos que participen en prácticas de crianza adicionales y fortalecedoras, y participaron en prácticas religiosas para refugiarse del estrés familiar. Proponemos consideraciones sobre intervenciones y otras áreas de investigación.