Long-term outcome of Boix-Ochoa and Nissen fundoplication in normal and neurologically impaired children

Purpose: The aim of this study was to compare the results of Boix-Ochoa and Nissen fundoplication performed in the authors' department in normal and neurologically impaired children. Methods: The medical records of all children who underwent fundoplication in the span of 10 years from 1988 to 1997 were reviewed. Boix-Ochoa procedure was the preferred operation before 1993. Since 1993, the Nissen fundoplication has been used as the operation of choice for surgical antireflux treatment. Results: A total of 109 fundoplications were performed during that period, of which 64.2% of the children involved were neurologically impaired. The Boix-Ochoa procedure and Nissen fundoplication were the 2 types of operations performed for antireflux surgical treatment. There were 22 recurrences of gastroesophageal reflux, 14 in the neurologically impaired group and 6 in the normal group. All except 2 recurrences were after the Boix-Ochoa procedure. Neurological impairment increased the morbidity rates after these procedures and dictated the effectiveness of the operation. Nissen fundoplication fared better in comparison with the Boix-Ochoa procedure in both the neurologically impaired and the normal group. Conclusions: Antireflux surgery is beneficial in children with significant gastroesophageal reflux, irrespective of their neurological status, although complications are more common in the neurologically impaired group. Nissen fundoplication is more effective and has fewer complications. J Pediatr Surg 35:1214-1216. Copyright © 2000 by W.B. Saunders Company.