[Late results after surgical treatment of gastroesophageal reflux in childhood]. / Pozdní výsledky po chirurgickém lécení gastroezofageálního refluxu v detském veku.

The authors present their long-term experience with surgical treatment of gastrooesophageal reflux (GER) in childhood. During the period between 1984-1993 they operated 243 children from neonatal age to 18 years. In 241 patients Nissen fundoplication was performed, once Thal's operation and once a modification of Boix-Ochoy's operation. Of 243 children 18 children (7.4%) died without any association with the operation, 5 children were re-operated on account of ileus, 5 developed a dehiscence of the surgical wound, 4 a paraoesophageal hernia and 2 a relapse of the reflux. The most frequent indication for surgery were relapsing bronchopneumonias 71 (29%), apnoe 44 (18%), impaired nutrition and growth 43 (17%), asthma bronchiale 38 (15%), oesophageal stricture 20 (8%), suffocating laryngitis 14 (6%) and incoordinated deglutition (5%). Two hundred and nine patients attended check-up examinations 3-13 years after surgery. 174 children (83%) do not have clinical manifestations of GER and no difficulties with swallowing. 27 children (13%) report marked improvement of the clinical manifestations of GER or slight difficulties when swallowing. Nissen fundoplication was a success in 96% children with GER. The authors recommend Nissen fundoplication for the surgical treatment of GER in child age because the long-term results with this method are favourable.

[Surgery of achalasia in childhood. The thoracic or abdominal approach?]. / Operace achalázie v detském veku. Hrudní nebo brisní prístup?

The authors present their experience with surgical treatment of achalasia of the oesophagus in child age. During a nine-year period (1984-1992) they operated 11 children with achalasia. The group comprised 6 boys and 5 girls. The mean age at the time of operation was 9.5 years. The youngest patient was operated at the age of 14 months and the oldest one at the age of 15 years. The main clinical symptoms at the time of establishment of the diagnosis were: vomiting in 91%, dysphagia in 64%, the children did not thrive and lost weight in 36%; they suffered from relapsing bronchopneumonia in 27%, chronic bronchitis in 9%, bronchial asthma in 9% and one female patient was treated and followed up on account of anorexia nervosa. In six patients a modification of Heller's operation was performed with left-sided thoracotomy which in three patients was supplemented by anti-reflux Belsey Mark IV plastic operation. During the last three years five patients were operated from an abdominal approach and myotomy was supplemented by Nissen fundoplication. At present the authors prefer and abdominal approach and supplement myotomy of the distal oesophagus by Nissen fundoplication.

[24-hour esophageal pH measurement in 52 children with gastroesophageal reflux]. / 24-hodinová jícnová pH-metrie u 52 detí s gastroezofageálním refluxem.

The authors give an account of their experience with 24-hour pH metry of the oesophagus in children. They made 56 examinations in 52 patients with different clinical complications of gastrooesophageal reflux (GER). The pathological finding during oesophageal pH-metry was in the great majority consistent with the pathological finding during oesophageal manometry. Of 52 children 18 patients were indicated for surgery on account of GER. The authors emphasize the advantages of 24-hour oesophageal pH-metry in particular as an auxiliary method in indications for surgery of gastrooesophageal reflux.