Gastroesophageal reflux after repair of congenital diaphragmatic hernia.

Research paper by Masafumi M Kamiyama, Hisayoshi H Kawahara, Hiroomi H Okuyama, Takaharu T Oue, Seika S Kuroda, Akio A Kubota, Akira A Okada

Indexed on: 17 Dec '02Published on: 17 Dec '02Published in: Journal of Pediatric Surgery


Mechanisms of postoperative gastroesophageal reflux (GER) remain unclarified in congenital diaphragmatic hernia (CDH). The aim of this study was to examine clinical features of CDH contributing to GER.GER was evaluated as esophageal acid exposure measured with 24-hour pH monitoring at the average age of 1.7 +/- 0.9 months in 26 survivors of CDH. Correlations between the percentage total time pH below 4.0 (reflux index: RI)/number of long acid reflux (long reflux) and clinical features were investigated. The subjects were divided into 2 groups; group A: RI < or = 4.0% (n = 7) and group B: R greater than 4.0% (n = 19). Clinical features were compared between the 2 groups.No significant correlation was noted between RI/long reflux and birth weight, preoperative AaDO2, duration of artificial ventilation, and dimension of the defect. The incidence of direct closure was significantly higher, but use of nitric oxide inhalation and a presence of intrathoracic liver lobe herniation were significantly lower in group B. There was no significant difference of other clinical features indicating the severity of CDH between the 2 groups.An association of GER is not rare in early infancy after repair of CDH, which is influenced by the repair methods.