Fundoplication for gastroesophageal reflux in neurologically impaired children: Surgical perspectives
Keywords:
Fundoplication, neurological impairment, childrenAbstract
Background: Gastroesophageal reflux is common in neurologically impaired children due to foregut dysmotility. Most of the patients eventually underwent fundoplication.
Objective: This study aimed to describe clinical data and outcome in children with neurological impairment who underwent fundoplication.
Methods: Patients (0 - 15 years) with neurological impairment undergoing fundoplication between January 2007 and December 2016 were retrospectively reviewed. Demographic data, surgical complications and short-term outcomes were collected and analyzed.
Results: Sixty-five patients (41 boys and 24 girls) underwent open fundoplication over the studied period. There were 21 infants (0 - 1 year, 32.0%), 41 children (1 - 10 years, 63.0%), and 3 adolescents (>10 years, 5.0%). The diagnosis of gastroesophageal reflux was based on impedance/24-hour pH monitoring (42.0%), gastric emptying scan (30.0%), esophagogram (18.0%), or endoscopy with biopsy (10.0%). Indication for fundoplication was refractory to medical therapy in all patients. Thirty-three (5.0%) of all patients already had gastrostomy performed at least one month prior to fundoplication. Surgical complications occurred in six patients (9.5%) including wound infections in 3 patients (5.0%), wrap failure in 2 patients (3.0%) and splenic injury requiring splenectomy in 1 patient (1.5%). Median follow-up time was 27 months. Postoperative outcome data were available in 50 patients. Thirty-five patients (70.0%) had clinical improvement, based on medical records or diagnostic tools. Redo-fundoplication was performed in 3 patients and all of them were in infancy group.
Conclusions: The majority of neurologically impaired patients had clinical improvement after fundoplication. Wound infection is the most common surgical complication after fundoplication. In addition, infancy was the age group risk for redo-fundoplication.
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