Surgical treatment of pediatric gastroesophageal reflux

Surgical treatment applied to pediatric gastroesophageal reflux (GER) has changed. Manometric studies and recently impedancemetry, but also side effects of a long-term medical treatment induced more precise surgical indications. The problem of selective indications remains opened, depending on the age and neurologic status, but also technical choice depends on the surgeon skills and habits. Results are better in case of respiratory or digestive symptoms versus severe neurological deficiency or associative malformations. Laparoscopic approach has provided advantages in term of recovery and follow-up requests, but every team is more confident with the antireflux montage previously adopted by the open way. Surgical side effects such as gaz bloat syndroms or para-esophageal hernias have been reduced in video-surgical series published for 10 years, a few of them accounting more than 200 pediatric cases. The main point is the reposition of esophageal sphincter below the hiatus. Moreover redo surgery is simpler by the laparoscopic route. In case of neurological deficiency, or multiple surgical failures, laparoscopic assisted gastrostomy or rare cases of gastro-esophageal deconnection can be required. In term of cost saving the modern surgical approach of gastroesophageal reflux could be a reality. But the learning curve is an other, and too many pediatricians are reluctant to propose surgical treatment for the chronic GER.