LARS is effective for therapy-resistant GERD

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Created On: 30/10/2020

LARS is effective for therapy-resistant GERD

A prospective, multicenter study was conducted to elucidate the long-term (five-year follow-up) effects of LARS in pediatric patients.

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Key take away

In children, laparoscopic anti-reflux surgery (LARS) is effective for therapy-resistant GERD as it shows improvement in reflux symptoms even after 5 years. The slight initial increase in HRQoL post-LARS appears to decline over time.

Background

A prospective, multicenter study was conducted to elucidate the long-term (five-year follow-up) effects of LARS in pediatric patients.

Method

From July 2011 and December 2013, the study recruited 25 pediatric patients from three hospitals in the Netherlands who underwent LARS. Participants were followed for a mean follow-up time of 5.2 years At three months and one, two, and five years postoperatively, patients and caregivers were requested to complete the gastroesophageal reflux symptom questionnaire to evaluate symptoms and the PedsQL™ to determine HRQoL.

Result

Compared with the preoperative levels, the reflux symptom severity was still remarkably improved 5 years after LARS. However, five years after LARS, moderate or severe reflux symptoms was witnessed in more patients compared to three months, as depicted in the following table and figure:

Notably, five years after LARS, dysphagia was observed in 13% of patients, as depicted in the following figure.

In children who underwent a Nissen procedure and in children with neurologic impairment, dysphagia was found to be more common. With time, the improvement in HRQoL three months postoperatively appears to decline. Notably, five years after surgery, HRQoL was lower, though not significantly, than three months postoperatively. HRQoL at five years was still improved, though also not significantly, than preoperative levels.