[Gastroesophageal reflux in children: analysis of 34 consecutive cases]. / Refluxo gastroesofagiano na crianca: análise de 34 casos consecutivos.

We studied 34 consecutive children from 6 m to 10 yr presenting gastroesophageal reflux (GER) with or without hiatal hernia. There was a high incidence of stenosis: 28 (80%) children presented with stenosis of the esophagus from mild to severe degree and 20 of them (70%) developed shortened or Barrett's esophagus. This data suggest that in our serie the diagnosis of GER has been delayed or medical therapy has been inadequate or excessively prolonged. The surgical treatment of GER with or without stenosis is the Nissen fundoplication. Our first cases of shortened esophagus were treated by intrathoracic Nissen fundoplication, which was considered an extensive and major risk surgery. Lately, for these cases we have been utilizing the gastro-fundoplication without opening of the chest. This is an easier surgery, through which we could reach good results without serious postoperative complications.

Refluxo gastroesofagiano na crianca: analise de 34 casos consecutivos. / Gastroesophageal reflux in children: analysis of 34 consecutive cases

O refluxo gastroesofagiano (RGE) leva a complicacoes esofagianas de gravidade quando nao tratado adequadamente. Na presente casustica observa-se uma notavel incidencia de complicacoes estenoticas do esofago, inclusive esofago encurtado. Este dado contrasta com a literatura pertinente e indica que, no nosso meio, o diagnostico do RGE tem sido feito tardiamente ou, ainda, que o tratamento clinico tem sido insatisfatorio ou excessivamente prolongado. Para o tratamento cigurgico do RGE com ou sem hernia hiatal associada, foi utilizada a gastroesofagoplicatura abdominal, com resultados uniformemente bons. Criancas com esofago encurtado foram inicialmente tratadas pela gastroesofagoplicatura intratoracica, cirurgia extensa e sujeita a riscos e complicacoes. Ultimamente, estas criancas tem sido tratadas pela gastrogastroplicatura abdominal, quando se alia a simplicidade tecnica a resultados satisfatorios