Gastoesophageal Reflux: Update Course 2015
With Dr. Mac Harmon & Dr. Whitt Holcomb & Dr. Dan von Almen · hosted by Dr. Todd Ponsky · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
More about gastroesophageal reflux disease
same diagnosisDive deeper → Gastroesophageal Reflux Disease (7 items)Podcast
Pediatric Gastroesophageal Reflux Disease
81 min · Published Aug 2018
Podcast
Gastroesophageal Reflux Disease
81 min · Published Aug 2018
Video
Gastroesophageal Reflux: Contemporary Management Pediatric Surgery Update...
32 min · Published Jul 2017
Podcast
Journal of Pediatric Surgery Article Review: October 2023
12 min · Published Apr 2024
Video
Top Themes From The Stay Current App
Published Sep 2020
Video
Gastric Neurostimulators: Update Course 2017
35 min · Published Aug 2017
Only a few other public items share this expert — go deeper there →
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
What the experts said
Children who wretch preoperatively have high likelihood of wretching postoperatively after fundoplication
There is a 95% chance fundoplication will be done successfully without need for another operation
Fundoplication is clinically 95% successful, though literature reports much higher failure rates depending on how recurrence is assessed
Immediate morbidity and mortality of laparoscopic fundoplication, even in infants, is very low and it is a safe operation
EE is less likely in infants given how early in the feeding process they are, but has been seen in very young children
Unrecognized motility disorders can be exacerbated by fundoplication, creating a functional obstruction that makes the situation more difficult
Eosinophilic esophagitis is becoming an issue across the board as the frequency of food allergies is skyrocketing in the pediatric population
PPIs do not stop vomiting; they make refluxed material less acidic
Long-term complications of laparotomy including bowel obstruction several years after open Nissen are underreported, with morbidity and even mortality from bowel obstruction related to laparotomy
The laparoscopic fundoplication should be the same operation done openly, just performed laparoscopically, so results should be the same
Whichever fundoplication technique (complete or partial) a surgeon does best, they should perform that technique
Transmigration was 90% of the reasons for needing to redo fundoplications in Birmingham and Kansas City practices
Trial of bolus NG tube feeding predicts whether infant needs fundoplication: if they do well with NG tube, perform G-tube alone; if they don't, perform Nissen
Bolus gastric feeding trial is the most helpful functional test for determining need for fundoplication, more informative than pH impedance probes
There is probably a 10-15% incidence of patients needing fundoplication after initial G-tube placement
Gastroesophageal reflux occurs in more than two-thirds of otherwise healthy infants and is discussed at 25% of all 6-month pediatric visits
2009 NASPGHAN and ESPGHAN guidelines state surgical approaches should be reserved for children with intractable symptoms unresponsive to medical therapy and those at risk for life-threatening complications of reflux disease
In adult literature, after about 15 years almost all fundoplications are undone
AAP guidelines note H2 antagonists or PPIs may have risk factors for pneumonia, gastroenteritis, candidemia, and NEC in preterm infants
Meta-analysis of 400 fundoplications versus 125 gastrojejunostomy tubes showed no difference in pneumonia rate or mortality, but 29% major complications in fundo group versus lower rate in GJ group, and 70% minor complications in GJ group
RCT of 44 laparoscopic versus 43 open fundoplications showed recurrence of reflux was 37% in laparoscopic group and only 7% in open group, with 5.2% higher risk of recurrence in laparoscopic group
RCT of laparoscopic versus open fundoplication in children under age 2 (21 open, 18 laparoscopic over 7 years) showed no difference in length of stay, time to full feeds, or analgesic requirements, but laparoscopic had longer operative time and higher surgical charges
Neurologically impaired patients do worse than neurologically normal patients after fundoplication according to historical data
Meta-analysis showed improved outcomes following complete fundoplication compared to partial wrap, though the difference was barely significant
Kansas City/Birmingham prospective RCT showed aggressive esophageal mobilization had 23% to 37% incidence of transmigration over 6.5 years, while minimal mobilization increased from 3% to 12%
Time to diagnosis of hiatal hernia was significantly longer in minimal mobilization group compared to maximum mobilization group
There was no significant difference in reflux symptoms or medication use between minimal and maximal mobilization groups at 6.5 years
Study showed 4% incidence of changes on upper GI prior to G-tube placement, with 80% of that 4% due to malrotation