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.