Background: Fundoplication is indicated in patient with gastroesophageal reflux disease (GERD) who need long-term medication, fail to response to optimal medication therapy, or have life-threatening complication.

Objective: To evaluate the outcome of GERD patients at 12 months after fundoplication.

Materials and Methods: This retrospective study includes children who were diagnosed GERD and underwent fundoplication between January 2006 and December 2018 at King Chulalongkorn Memorial Hospital. Studied outcomes were the need of antireflux medications, prevalence of persistent symptoms, GERD-related hospitalization rate, re-operation rate, and mortality rate at 12 months after fundoplication.

Results: Overall, 59 patients (49% male) were included in the study. The median age [IQR] at the time of GERD diagnosis and fundoplication was 11 [5-48] and 18 [8-66] months, respectively. All children had comorbid conditions, the most common of which was neurological impairment (n=48, 81%). Fifty-seven and 2 patients underwent Nissen and Thal fundoplication, respectively. At 12-month follow-up, 30 (51%) were prescribed antireflux medications and 25 (42%) had persistent GERD symptoms. The median [IQR] hospitalization rate was 2.5 [2-3] times/year. Only 1 (1.7%) patient, who had esophageal atresia and tracheoesophageal fistula, underwent reoperation due to fundoplication disruption. There were 9 deaths (15.3%). Causes of death were GERD-related aspiration pneumonia (n=1), sepsis (n=5), hospital-acquired pneumonia (n=2), and recurrent ependymoma (n=1).

Conclusion: Most patients with GERD who have comorbid conditions have persistent symptoms and need continuing antireflux medications after fundoplication. Therefore, long-term follow-up of GERD patients following fundoplication is essential, particularly those at risk of a high failure rate of fundoplication.