ESOPHAGEAL MOTILITY AND GASTROESOPHAGEAL REFLUX AFTER REPAIR OF CONGENITAL DIAPHRAGMATIC HERNIA

Huimin Xia, Zhiqiang Zhi, Shuiquing Li

Department of Pediatric Surgery, Guangzhou Children Hospital, Guangzhou, China

 

Background:  Gastroesophageal reflux (GER) is increasingly reported after surgical repair of congenital diaphragmatic hernia (CDH), This study examines the outcomes of after repair CDH and examines the results esophageal motility and pH testing after repair CDH.

Methods: An analysis of a data base containing all patients undergoing congenital diaphragmatic hernia repair between 1990 and 2000.follow-up was performed under protocol and consisted a symptoms assessment, 17 case of among 56 case were reviewed for Gastroesophageal reflux (GER) assess by the combined ambulatory 24-hour manometric and pH-meter.

Results: 50 of 56 patients at the author’s hospital survived after repair of CDH, 38 of them were interview examined clinically. 17 patients have clinical signs of GER, others without typical clinical signs had documented GER. 17 underwent pH and manometric testing 24-h pH monitoring and manometer revealed pathological gastroesophageal reflux in 9 patients. The results were compared with those of 18 healthy controls. The overall incidence of GER was 23.9%. 3 of them had used diaphragmatic patches during hernia repair. 4 of them have preoperative thoracic position of the stomach. Ambulatory manometer results confirmed the amplitude of peristalsis at the distal esophagus was significantly Decreased compared to patients without GER. Acid clearance also significantly prolonged in the GER subgroup

Conclusions: That GER patients after repair CDH present with an increased amount of reflux results in more severely impaired esophageal peristalsis as compared to patients without GER. Prolonged acid clearance and impaired esophageal Motility observed in patients with GER could be the result of both anatomy of the gastroesophageal junction and the reduced peristaltic activity of the esophagus.

 

 
2765