the role of anti-reflux surgery in the management of respiratory symptoms in gastro-esophageal reflux disease

introduction: gastro-esophageal reflux (ger) is common among children of different ages and treatment is necessary since it could turn in to gastroesophageal reflux disease (gerd) and cause complications. in patients that do not respond to medical treatment and patients that have complications such as repeated apnea, pneumonia, stricture caused by esophagitis and failure to thrive, surgical treatment is indicated. in this article the rates of clinical presentations of the disease particularly the respiratory manifestations after operation with the loose nissen fundoplication technique are studied. material and methods: in this descriptive retrospective study 76 cases of gerd underwent loose nissen fundoplication. clinical presentations and diagnostic methods and the result of surgical treatment were studied. results: during march 1997 till august 2010, 76 patients were studied. male to female ratio was 1.6. the mean age of patients was 24.5 months (ranging between 17 days to 18 years).  fifty nine (78%) patients had respiratory presentations such as rad (reactive airway disease) and respiratory distress with recurrent pneumonia and apnea. thirty one (41%) cases had associated anomalies. the most used diagnostic studies were radiography (100%), endoscopy (41%) and ph metry (1.3%). eleven patients (14.4%) had early or late surgical complications. respiratory presentations in almost all the patients were controlled postoperatively. the success rate of the operation was 75 (98.6%). there was no operative mortality, but non-operative mortality occurred in one patient (1.3%). conclusion: loosenissen fundoplication technique has a good success rate with a low rate of complications.  respiratory presentations are the most common presentations of gerd, and in all patients who have respiratory symptoms, gerd workup is necessary, and anti-reflux surgery can control nearly all of these symptoms.                                                                                           keywords: gastro-esophageal reflux, children, loose nissan fundoplication, respiratory   symptoms