***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND / PURPOSE It is reported that the main mechanism responsible for gastroesophageal reflux ( GER ) is transient lower esophageal sphincter ( LES ) relaxation in children . However , the effect of Nissen fundoplication on transient LES relaxation has not been investigated in children . This study examined the effect of Nissen fundoplication on motor patterns of the LES in children with pathological GER . METHODS Esophageal manometry and pH were recorded concurrently for 2 hours after administration of apple juice ( 10 mL/kg ) . In seven children documented to have pathological GER by prolonged esophageal pH monitoring ( % time pH less than 4.0>5.0 ) , studies were performed preoperatively and 1 to 3 months after surgery . RESULTS Nissen fundoplication virtually eliminated reflux in all patients . Percentage of time pH was less than 4.0 reduced from 15+/-9 to 0+/-0 . Basal LES pressure did not change significantly ( pre , 21+/-10 mm Hg v post , 27+/-9 mm Hg ) . The number of transient LES relaxation reduced significantly from 13+/-4 to 7+/-7 , and the mean nadir LES pressures during swallow-induced LES relaxation and transient LES relaxation increased significantly from 1+/-1 mm Hg to 13+/-5 mm Hg and from 0+/-0 mm Hg to 11+/-7 mm Hg , respectively . CONCLUSIONS Our findings suggest the antireflux effects of Nissen fundoplication may be based on changes of LES motor patterns that result in incomplete LES relaxation and reduction of the number of transient LES relaxation OBJECTIVES To study the effect of Nissen fundoplication and gastrostomy in severely neurologically impaired children . DESIGN Prospect i ve observational study . SETTING Developmental Disabilities Unit of a regional medical centre in Hong Kong . PATIENTS Children with severe neurological impairment and gastroesophageal reflux who were institutionalised between 1999 and 2004 inclusive . MAIN OUTCOME MEASURES Incidence of vomiting , gastro-intestinal bleeding , and pneumonia in the baseline year and consecutive years following surgery ; 24-hour oesophageal pH monitoring ; recurrence rate ( determined by 24-hour oesophageal monitoring ) ; body weight ; complications of surgery ; and mortality . RESULTS Twenty children , with a mean age at surgery of 8.5 ( st and ard deviation , 3.5 ) years , were recruited .  Nissen fundoplication was performed in nine children and 11 children underwent laparoscopic fundoplication .  Children were monitored for 1.3 to 5.7 years ( median , 3.5 years ) after surgery . The incidence of vomiting and gastro-intestinal bleeding was significantly decreased following surgery ( P < 0.001 and P = 0.001 , respectively ; Friedman 's test ) . There was no difference between the preoperative and postoperative incidence of pneumonia ( P = 0.973 , Friedman 's test ) . The median reflux index was reduced from 5.7 % to 0.15 % after surgery but six ( 30 % ) patients had recurrent gastroesophageal reflux . The mean body weight was 17.4 kg ( st and ard deviation , 4.7 kg ) at baseline and 22.8 kg ( st and ard deviation , 4.4 kg ) at the end of follow-up ( P < 0.05 , Student 's t test ) . One patient had mild dumping syndrome soon after fundoplication . One patient had one episode of intestinal obstruction . Four patients died 1.9 to 5.0 years following surgery due to respiratory disease . CONCLUSION Our results indicate that in severely neurologically impaired children with gastroesophageal reflux , vomiting , gastro-intestinal bleeding , and reflux indices based on 24-hour oesophageal pH monitoring were significantly reduced following fundoplication and gastrostomy . The incidence of pneumonia was unchanged . The recurrence rate of reflux was 30 % and mortality rate was 20 % Background : Skepticism is still present today about the laparoscopic treatment of gastro-esophageal reflux ( GER ) in children . We present the prospect i ve experience and short-term results of eight Italian pediatric surgical units . Methods : We included all the children with complicated GER , operated after January 1998 by single surgeons from eight different centers . Diagnostic aspects , type of fundoplication , and complications were considered . All the patients were followed for a minimum period of 6 months in order to detect complications or recurrences . Results : 288 children were prospect ively included . Mean age was 4.8 years ( 3 m–14 y ) .  Nissen fundoplication was done in 25 % , floppy Nissen in 63 % , Toupet in 1.7 % , and anterior procedures ( Lortat Jacob , Thal ) in 10 % . Gastrostomy was associated , if neurological impairment or feeding disorders were present . Mean follow-up was 15 months and reoperation was necessary in 3.8 % of cases . Conclusions : This experience underlines that minimal invasive access surgery in children is safe and that the laparoscopic approach is considered in eight centers the golden st and ard for surgical repair of gastro-esophageal reflux disease maintaining the same indications and techniques of the open approach Laparoscopic antireflux surgery has been performed in neurologically impaired and scoliotic children . We aim ed to assess the effectiveness of laparoscopic fundoplication in mentally normal children with gastroesophageal reflux disease that failed to respond to medical therapy . Data were prospect ively collected ( symptoms , medical therapy , endoscopies ' findings ) on 12 children ( nine boys , three girls ) aged 9 - 15 years with gastroesophageal reflux disease .  Pre- and postoperative ambulatory 24-h pH and DeMeester and Johnson scores were also recorded . Effectiveness of surgery was assessed by comparison of pre- and postoperative total acid exposure time , Visick grade , need for antireflux medication and symptom scores . In total , 11 children underwent a laparoscopic Nissen fundoplication  and one underwent a Toupet procedure .  Median length of stay was 2 ( 2 - 3 ) nights . The median preoperative pH acid exposure time ( AET ) was 4.7 ( 0.8 - 16.4 ) percent compared with postoperative AET of 0.4 ( 0 - 3 ) percent . Early postoperative dysphagia occurred in four out of 12 patients , requiring a total of six dilatations . Postoperative Visick scores were : grade I=7 and grade II=5 . Laparoscopic fundoplication can be safely performed and is effective in children with GERD who have failed to respond to medical therapy Aim : We investigated the impact of laparoscopic anterior hemifundoplication on gastric emptying ( GE ) and specific symptoms in children with and children without neurodevelopmental delays gastroesophageal reflux . Scintigraphic and ultrasonographic GE measurements were correlated . Patients and Methods : Twenty-six children ( mean age 7 ± 6.1 years ) , of whom 14 were neurodevelopmentally delayed , were evaluated prospect ively before 3 and 6 months after laparoscopic anterior hemifundoplication .  All of the patients underwent clinical assessment s , interviews , and 24-hour pH monitoring . Key symptoms were evaluated using a 5-point Likert scale . Gastric emptying was assessed by Tc-99m-DTPA-scintigraphy and ultrasonography . Results : All of the children had significant catch-up growth after fundoplication , which was more pronounced in the neurologically normal children ( P < 0.05 vs impaired ) , in line with a decrease in the use of omeprazol ( mean 0.93 ± 0.7 mg · kg−1 · day−1 before and 0.06 ± 0.18 mg · kg−1 · day−1 at 6 months after operation ; P < 0.001 ) . The 24-hour pH monitoring normalized in all of the children , and the mean severity of the key symptoms such as vomiting , choking , and pain was significantly reduced ( P < 0.001 ) . Scintigraphic GE parameters , such as the elimination rate/minute , gastric half-emptying time ( t1/2 ) , gastric residual activity ( RA ) , and duration of the initial merging time , were not altered significantly by the operation ( P > 0.05 ) . Ultrasonographic evaluations confirmed these results [ positive correlation with scintigraphy for t1/2 ( P = 0.006 ) and RA ( P = 0.01 ) ] . The symptoms evolution and GE were uncorrelated ( P > 0.01 ) . There were no significant differences between children with and children without neurodevelopmental delays . Conclusions : Laparoscopic anterior hemifundoplication achieves an excellent symptomatic outcome without affecting GE in children with and children without neurodevelopmental delays Objectives : Bloating , abdominal pain , and early satiety have been reported in up to 30 % of patients after Nissen fundoplication .  We hypothesized that these postsurgical complications in children and young adults are linked to either the effects of surgery on gastric sensation , compliance or motor function or to preexisting physiological abnormalities . Methods : We prospect ively evaluated the effect of Nissen fundoplication on gastric sensory and motor functions in 13 children with gastroesophageal reflux . Gastric barostat and mixed meal gastric emptying studies were performed before surgery in all patients and were repeated after surgery in 8 and 9 children , respectively . Results : Thirteen patients ( median age , 7 years ; range , 6 months to 18 years ) underwent open Nissen ( n = 6 ) or laparoscopic Nissen fundoplication  ( n = 7 ) . After fundoplication , patients had significantly higher minimal distending pressure values ( 10 mm Hg vs 3 mm Hg pre-Nissen , respectively ; P < 0.001 ) , reduced gastric compliance ( slope values of 8.39 mm Hg vs 9.15 mm Hg , respectively , P < 0.001 ) and significantly higher pain scores ( P < 0.001 ) . Presurgery and postsurgery gastric emptying at 60 , 90 and 120 minutes after feeding showed no significant changes . Conclusions : After Nissen fundoplication , children with gastroesophageal reflux manifest the following : ( 1 ) reduction in gastric compliance , ( 2 ) increase in minimal gastric distending pressure , ( 3 ) exacerbation of the sensations discomfort with gastric distension and ( 4 ) no effect on gastric emptying Background The laparoscopic approach has become increasingly popular for fundoplication over the last few years ; however many surgeons are skeptical about its real advantages . Methods We conducted a prospect i ve comparative study of children operated on for gastroesophageal reflux ( GER ) . Exclusion criteria included age < 1 year and > 14 years , previous surgery on the esophagus or stomach , and neurologic impairment . We compared two groups of patients who met the same inclusion /exclusion criteria . One group was treated via a  laparotomic approach between January 1993 and December 1997 ; the other was treated via a laparoscopic approach between September 1998 and December 2000 . A 360 ° wrap was performed in each group . Results Group 1 ( laparotomic approach  ) included 17 patients ; mean operative time was 100 min and postoperative time was 7 days . Group 2 comprised 49 children operated on via a laparoscopic approach ; mean operative time was 78 min and postoperative time was 48 hours . No major complications were encountered in either group . In postoperative period , two patients in group 1 had complications . One had a prolonged bout of gastroplegia , which required nasogastric drainage , and then recovered spontaneously after 20 days ; the other had stenosis of the wrap , which required dilation . No relapses occurred during a follow-up of 6 months . Longterm follow-up data are not presented . Comparative analysis of the short-term functional results indicated that there were no differences between the two groups . Conclusion This study confirms that the minimally invasive approach is safe and effective for the treatment of primary gastroesophageal reflux disease in children CONTEXT AND OBJECTIVE Association between neurological lesions and gastroesophageal reflux disease ( GERD ) in children is very common . When surgical treatment is indicated , the consensus favors the fundoplication technique recommended by Nissen , despite its high morbidity and relapse rates . Vertical gastric plication is a procedure that may have advantages over Nissen fundoplication , since it is less aggressive and more adequately meets anatomical principles . The authors proposed to compare the results from the Nissen and vertical gastric plication techniques . DESIGN AND SETTING R and omized prospect i ve study within the Postgraduate Surgery and Experimentation Program of UNIFESP-EPM , at Hospital do Servidor Público Estadual ( IAMSPE ) and Hospital Municipal Infantil Menino Jesus . METHODS Fourteen consecutive children with cerebral palsy attended between November 2003 and July 2004 were r and omized into two groups for surgical treatment of GERD : NF , Nissen fundoplication ( n = 7 ) ; and VGP , vertical gastric plication ( n = 7 ) . These were clinical ly assessed by scoring for signs and symptoms 
    Output:
    
However , less postoperative dysphagia was observed after partial fundoplication and laparoscopic ARS was associated with less pain medication and a shorter hospital stay .
Complications of ARS varied from minimal postoperative complications to severe dysphagia and gas bloating .
Conclusion  ARS in children shows a good overall success rate ( median 86 % ) in terms of complete relief of symptoms .
Efficacy of ARS in neurologically impaired children may be similar to normally developed children .
The outcome of ARS does not seem to be influenced by different surgical techniques , although postoperative dysphagia may occur less after partial fundoplication .