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Life Span of Nissen Fundoplication

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Question

It has been recommended that because my child with CdLS had reflux surgery at least 10 years ago follow-up should be done to ensure that the wrap is not coming loose. When I went to the specialist his feeling was that if she is not vomiting then a test is not warranted. Is there written information available that says different?

Answer of our experts

If the child isn't vomiting and there is no evidence of other complications such as esophagitis or lung disease, I would not look to see if the Nissen is intact because there would be no reason to do anything about the result. A Nissen fundoplication should only be “checked” if there is a problem

The life of a Nissen is influenced by many things, such as the amount of vomiting and gagging, and luck. Nissens can last as short as a few weeks and much longer than 10 years

CP/ TK 7-13-10

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Recommendation(s)

Reflux

R32
Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
R33
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
R34
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
R35
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.

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