Gastroesophageal Reflux and Other Disorders of Esophageal
Function Fundoplication is currently either the first or the
second most commonly performed intra-abdominal procedure in
infants and children in most pediatric surgical centers. Since
the 1970s, surgical correction for gastroesophageal reflux (GER)
has been performed by wrapping the upper stomach around the
esophagus either a partial (Thal, Boix-Ochoa, Dor, Toupet) or
complete (Nissen) fundoplication. In general, it seems that the
Nissen fundoplication is more effective in preventing GER, but
it may lead to difficulty swallowing and troublesome bloating in
some patients compared with a partial fundoplication, which
seems not as effective in preventing reflux. These symptoms
after the Nissen procedure seem to be minimized with use of an
appropriate-sized esophageal tube used as a “sizer” and division
of the blood vessels that attach the stomach to the spleen for
sufficient mobilization of the stomach. In contrast to
physiologic vomiting, GER can present