Retching and vomiting in neurologically impaired children after fundoplication: predictive preoperative factors

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Neurology

Background:

• Retching and vomiting are frequent complications following Nissen fundoplication in neurologically impaired children.
• Identifying predictive factors for these postoperative symptoms is crucial for patient management.

Purpose of the Study:

• To determine if preoperative clinical factors can predict the occurrence of retching and vomiting after Nissen fundoplication in neurologically impaired children.

Main Methods:

• A prospective study of 20 neurologically impaired children undergoing Nissen fundoplication for gastroesophageal reflux.
• Detailed preoperative history of feeding-related behaviors and symptoms was collected.

Main Results:

• Children were classified preoperatively into two groups based on symptoms: Group A (gastroesophageal reflux only) and Group B (emetic reflex activation).
• Postoperatively, 0 out of 8 children in Group A experienced retching, compared to 8 out of 12 in Group B (P < .005).

Conclusions:

• Preoperative identification of symptoms related to emetic reflex activation can predict postoperative retching and vomiting.
• Antireflux surgery may be inappropriate for children with these specific preoperative indicators, suggesting potential avoidance.
• Clinical assessment preoperatively can stratify risk for adverse outcomes after fundoplication.