Nissen fundoplication and combined procedures to reduce recurrence of gastroesophageal reflux disease in neurologically impaired children

Abstract

Neurologically impaired children account for almost half of the fundoplication procedures performed for gastroesophageal reflux disease. Aim of the present study was to report results of antireflux surgery in neurologically impaired children. A retrospective study of neurologically impaired children who underwent fundoplication over a 13-year period (1999-2012) was performed. Recurrence rate, major complications and parents/caregivers perceptions of their child's quality of life following antireflux surgery were analyzed. A total of 122 children (median age: 8 years 9 months; range: 3 months to 18 years) had open "tension-free" Nissen fundoplication, gastrostomy + /− pyloroplasty. Gastroesophageal reflux disease was in all cases documented by at least two diagnostic exams. Median duration of follow-up was 9.7 (1.9-13) years. Three (2.4%) recurrences were documented and required surgery redo. Major complications were 6%. Seventy-nine of 87 (90%) caregivers reported that weight gain was improved after fundoplication with a median score of 1 (IQR: 1-2). Significant improvement was perceived in postoperative overall quality of life. In this series of fundoplication recurrence incidence was low, serious complications were uncommon and caregivers' satisfaction with surgery was high. Accurate patient's selection and creating a "low-pressure" surgical system are mandatory to obtain these results.

Experience with a Hybrid Procedure Involving Laparoscopic Fundoplication with Percutaneous Endoscopic Gastrostomy in Chronically Ill Children

“…Third, in PEG with LNF, the LNF status can be assessed immediately after surgery. The major complications of LNF are excessive tightening and reinforcement of the lower esophageal sphincter (LES) [ 8 ]. PEG performed simultaneously with fundoplication can help in the evaluation of the tightness of the fundoplication at the time of surgery.…”

Is There a Role for Elective Early Upper Gastrointestinal Contrast Study in Neurologically Impaired Children following Laparoscopic Nissen Fundoplication?

“…Different reports examine factors associated with redo Nissen fundoplications in children. A typical combined procedure during laparoscopic fundoplication is the simultaneous placement of a gastrostomy, especially in NI children [ 20 ]. There is certainly a lack of data investigating a potential impact of pre-existing gastrostomy or concomitant placement of a gastrostomy during laparoscopic Nissen fundoplication in NI patients.…”

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

“…Asimismo, no se evaluó el grado de satisfacción de padres o cuidadores de los pacientes con relación a la cirugía a través de encuestas o scores, como ha sido referido en la bibliografía. 17…”