Postfundoplication retching: Strategies for management

被引:2
|
作者
Richards, Catherine A. [1 ]
机构
[1] Guys & St Thomas NHS Fdn Trust, Evelina London Childrens Hosp, Dept Paediat Surg, Westminster Bridge Rd, London SE17EH, England
关键词
Retching treatment; Fundoplication; Vomiting reflex; Emetic reflex; Neurodisability; Gastroesophageal reflux; NEUROLOGICALLY IMPAIRED CHILDREN; GASTROESOPHAGEAL-REFLUX DISEASE; LAPAROSCOPIC NISSEN FUNDOPLICATION; RANDOMIZED CONTROLLED-TRIAL; GASTRIC-MOTILITY; DYSPEPTIC SYMPTOMS; ANTIREFLUX SURGERY; PERCUTANEOUS GASTROJEJUNOSTOMY; ESOPHAGOGASTRIC DISCONNECTION; PEDIATRIC GASTROENTEROLOGY;
D O I
10.1016/j.jpedsurg.2020.03.032
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background: Retching is a common symptom in children following antireflux surgery, particularly in those with neurodisability. There is now a strong body of evidence that implicates retching as a major cause of wrap breakdown. Retching is nota symptom of gastroesophageal reflux disease; it is a component of the emetic reflex. In addition to causing wrap breakdown, it is indicative of the presence of nausea. It is a highly aversive experience and warrants treatment in its own right. Methods: A framework was constructed for the management of postoperative retching, with strategies targeting different components of the emetic reflex. The impact of differing antireflux procedures upon retching was also considered. Conclusions: Once treatable underlying causes have been excluded, the approach includes modifications to feeds and feeding regimens, antiemetics and motility agents. Neuromodulation and other, novel, therapies may prove beneficial in future. Children at risk of postoperative retching may be identified before any antireflux surgery is performed. Fundoplication is inappropriate in these children because it does not treat their symptoms, which are not because of gastroesophageal reflux, and may make them worse. They are also at risk of wrap disruption. Alternative strategies for symptom management should be employed, and fundoplication should be avoided. (C) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:1779 / 1795
页数:17
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