Authors: Femke A Mauritz Rebecca K Stellato L W Ernst van Heurn Peter D Siersema Cornelius E J Sloots Roderick H J Houwen David C van der Zee Maud Y A van HerwaardenLindeboom
Publish Date: 2016/11/18
Volume: 31, Issue: 8, Pages: 3122-3129
Abstract
Improving healthrelated quality of life HRQoL is increasingly recognized as an essential part of patient care outcome Little is known about the effect of laparoscopic antireflux surgery LARS on the HRQoL in the pediatric patients The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease GERD and to identify predictors that influence HRQoL outcome after LARSBetween 2011 and 2013 25 patients with therapyresistant GERD median age 6 2–18 years were included prospectively Caregivers and children with normal neurodevelopment 4 years were asked to fill out the validated PedsQL 40 Generic Core Scales before and 3–4 months after LARSThe PedsQL was completed by all caregivers n = 25 and 12 children HRQoL total score improved significantly after LARS both from a parental p = 0009 and child’s perspective p = 0018 The psychosocial health summary and physical health summary scores also improved significantly after LARS HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment p 0001 However neurodevelopment did not influence the effect of LARS on HRQoL The only significant predictor for improvement in HRQoL after LARS was age at the time of operation p = 0001HRQoL significantly improves after LARS Although children with impaired neurodevelopment had lower overall HRQoL neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS Older children have a more favorable HRQoL outcome after LARS compared to younger children This may suggest caution when considering LARS in younger GERD patientsLaparoscopic antireflux surgery LARS is an established treatment option performed in pediatric patients with severe gastroesophageal reflux disease GERD resistant to medical treatment 1 2 LARS primarily aims to decrease acid reflux events and to reduce reflux symptoms However as shown in earlier studies the effect on reflux symptoms does not always correlate to more objective assessments of success of therapy 3 4 Furthermore comorbidities eg impaired neurodevelopment and complications such as dysphagia and gasbloat syndrome 5 may also affect success of therapyTo better assess the impact of pediatric diseases and treatments from the perspective of the pediatric patient and their caregivers healthrelated quality of life HRQoL assessment has been increasingly recognized as an essential part of patient care outcome 6 Effects of LARS on HRQoL have been mainly investigated in adult population These studies almost all showed that HRQoL improves after LARS 7 8 9 In the pediatric population only few studies have focused on this outcome parameter 10 11 12 HRQoL in these studies improves however none of these studies have used pediatric validated questionnaires In two studies 10 11 a questionnaire designed for adults had been modified for pediatric use and one study had only used parental proxy report to score HRQoL 12 Furthermore none of these studies could identify determinants that influence HRQoL outcome after LARS The Pediatric Quality of Life Inventory http//wwwpedsqlorg 40 Generic Core Scales PedsQL is a reliable and valid tool also for the Dutch language for parental proxy report and parallel child’s selfreport on HRQoL It has been used to assess HRQoL in children with numerous acute and chronic health conditions as well as in healthy populations 6 13 14 15 16 17 The aim of this study was to evaluate the effect of LARS on HRQoL using the PedsQL and to identify predictors that may influence HRQoL outcome after LARSWe performed a prospective multicenter study in three University Medical Centers in the Netherlands performing laparoscopic fundoplication in children Wilhelmina children’s Hospital University Medical Center Utrecht UMCU Sophia children’s Hospital Erasmus University Medical Center EMC and Maastricht University Medical Center MUMC From July 2011 until December 2013 we prospectively included all pediatric patients diagnosed with PPItherapyresistant GERD Patients that had undergone previous esophageal or gastric surgery except previous gastrostomy placement and those who had structural abnormalities other than an esophageal hiatal hernia were excluded
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