Enfermedad por reflujo gastroesofágico y enfermedades neurológicas en pediatría: complicaciones funcionales y motoras post funduplicatura de Nissen

Abstract

Motility disorders are frequent in children with cerebral palsy. The prevalence of gastroesophageal reflux disease varies from the 15% to 75% in patients with cerebral palsy. Nissen fundoplication is the most used antireflux technique not without complications in this population. Our objective was to determine the frequency and the characteristics of the long-term functional and motility complications in patients with Nissen fundoplication and cerebral palsy. A descriptive cross-sectional study was performed. Data collection was acquired retrospectively with neurologic compromise between 2012 and 2017 in patients between 0 to 18 years old, with neurological impairment and Nissen fundoplication. 35 patients were included. Median age was 55 months (2-190). Gastroesophageal reflux disease was diagnosed in the 48%, in the 52% of this the diagnosis was clinical. It was performed by laparoscopic technique in the 91.4% of the cases gastrostomy was done in the same surgical time in 86% of the patients because of neurological impairment and risk of aspiration. In 25.7% (n = 9) there were functional and motor complications, Dumping syndrome (5.5%) accommodation disorders (11.4%) and recurrence of reflux (11.4%). Redo Nissen was required in the 8.5% of the patients (n = 3). In 75% of the patients with complications, gastrostomy was performed in the same surgical time. It could not be demonstrated that gastrostomy at the time of antireflux surgery was associated with greater frequency of complications.

Evaluación de la gastrostomía percutánea con funduplicatura de Nissen mínimamente invasiva versus cirugía abierta, en niños con parálisis cerebral infantil

“…Knowing that the prevalence of gastroesophageal reflux symptoms is high and its clinical characteristics continue to be investigated around the world [6], this problem is given great attention in the pediatric population since in their anatomy, physiology, and pharmacology, children, especially the smallest ones, differ from adults [7]. As the most widely used surgical procedure in cases of gastroesophageal reflux in the pediatric population, Nissen fundoplication has been a safe and highly effective technique, which is why it is considered the technique of choice [8][9][10].…”