ABSTRACT
Nissen fundoplication is indicated in infants and children who have complications of gastroesophageal reflux which are not adequately controlled with dietary modification and medical therapy. This principle can be difficult to operationalize because many symptoms attributed to gastroesophageal reflux can overlap with concomitant disease such as reactive airway disease, failure to thrive, feeding difficulties, irritability-related developmental delay, and cerebral palsy. Most infants with gastroesophageal reflux have only physiologic reflux and can be managed expectantly as the gastroesophageal reflux will decrease over the first year of life. Older children present with gastroesophageal disease with more typical esophageal symptoms. Children with neurological impairment have frequent foregut symptoms which can include retching after feedings, poor tolerance of gastric feedings, and frequent emesis. Gastroesophageal reflux is very common in children who have undergone repair of esophageal atresia. Fundoplication should be considered for infants who have increased frequency of vomiting, feeding intolerance, or pulmonary events during gastric feedings.
