Specialist Neonatal and Paediatric Surgery clinical outcomes

This page gives a brief overview of the Specialist Neonatal and Paediatric Surgery Department and some of the conditions it treats. It provides more information on gastro-oesophageal reflux and how it measures the results of one its procedures, Nissen fundoplication, at Great Ormond Street Hospital (GOSH).

Overview of the Specialist Neonatal and Paediatric Surgery Department

The Specialist Neonatal and Paediatric Surgery (SNAPS) Department at Great Ormond Street Hospital (GOSH) provides specialist surgical treatment for newborn babies and children with congenital (present at birth) conditions as well as diseases of the gastrointestinal tract.

The department has an excellent international reputation and continues to develop new ways of treating newborn babies and children, such as oesophageal replacement surgery and minimally invasive (keyhole) surgery.

The SNAPS Department works closely with a number of other departments within GOSH, including radiology, urology, dietetics and gastroenterology among others.

Referrals are made in most cases via local hospital consultants, community paediatricians or in exceptional circumstances via a GP.

The following information details the results for patients with gastro-oesophageal reflux undergoing treatment with a Nissen fundoplication at GOSH.

Overview of gastro-oesophageal reflux and Nissen fundoplication

Normally, when we swallow food and drink, it moves down the foodpipe (oesophagus) to the stomach, where it starts to be broken down by the acids released from the stomach wall.

When a baby or child has gastro-oesophageal reflux, the food and drink travels down the foodpipe as normal, but some of the mixture of food, drink and acid travels back up the foodpipe, instead of passing through to the large and small intestines. This is caused because the sphincter muscle at the top of the stomach doesn’t close well. This is called gastro-oesophageal reflux disease.

As the food and drink is mixed with acid from the stomach, it can irritate the lining of the foodpipe, making it sore. Some children also breathe some of the mixture into the windpipe (aspiration), which can irritate the lungs and cause chest infections.

One of the most common procedures carried out by the SNAPs Department at GOSH is a Nissen fundoplication.

A Nissen fundoplication is an operation used to treat gastro-oesophageal reflux. It uses the top of the stomach to strengthen the sphincter muscle so it is less likely to allow food, drink or acid to travel back into the foodpipe.

Some babies and children also have a gastrostomy during the same operation. A gastrostomy is a surgical opening through the abdomen into the stomach. A feeding device is inserted through this opening into the stomach. This allows your child to be fed directly into his or her stomach, bypassing the mouth and throat.

Nissen fundoplication may become less effective in some cases after a few months or years because the valve weakens and then some of the symptoms of gastro-oesophagel reflux return.

If the reflux is significant for the child the operation may need to be repeated. A repeated Nissen fundoplication means undoing what is left of the old stomach wrap and doing the operation again.

How do we measure the results of Nissen fundoplication?

To capture the success of Nissen fundoplication, the SNAPS Department records the success rate of the procedure. While the initial Nissen fundoplication operation is always successful, over time it may become less effective and some symptoms of reflux may return.

Therefore success in this case is defined as the correction of the gastro-oesophagel reflux where there is no need for further repeat nissen fundoplication, referred to as a ‘re-do’ or ‘revision surgery’.

The vast majority of patients treated by the SNAPs Department at GOSH for gastro-oesophagel reflux have other complex medical conditions which could influence the likelihood of re-do surgery.

Nissen fundoplication surgery success results

89 per cent of patients have undergone Nissen fundoplication between 2003 and 2011 and to date have not needed repeat surgery. 11 per cent of patients treated between 2003 and 2011 have required at least one repeat nissen fundoplication surgery.

This reflects standards of success as identified in research across the world which indicate likely success rate of between 76 and 98 per cent.

The following table shows the number of patients undergoing nissen fundoplication each year and the number that then required at least one repeat surgery:

Of the 94 patients that needed repeat surgery the average time between the first operation and the second was 18 months.

80 per cent of patients that had repeat surgery needed this within two and a half years.

Therefore the number of patients treated in more recent years may still go on to require repeat surgery and this information is presented as a snap shot in time only.

About the information

This information was taken from our patient administration and information system where details of operations are recorded for every patient. There is a specific code for the first nissen operation and a specific code for a repeat nissen operation.

We excluded any patient where the first operation code was reported on more than one occasion.

This information was produced in March 2012 and will be updated in March 2013.

Glossary

Gastro-oesophageal reflux disease - the food and drink travels down the foodpipe as normal, but some of the mixture of food, drink and acid travels back up the foodpipe, instead of passing through to the large and small intestines.

Nissen fundoplication- uses the top of the stomach to strengthen the sphincter muscle so it is less likely to allow food, drink or acid to travel back into the foodpipe.

Gastrostomy - a gastrostomy is a surgical opening through the abdomen into the stomach. A feeding device is inserted through this opening into the stomach. This allows your child to be fed directly into his or her stomach, bypassing the mouth and throat.