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Early laparoscopic fundoplication and gastrostomy in infants with spinal muscular atrophy type I

Emily T Durkin1, Mary K Schroth, Margaret Helin

  • 1Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-7375, USA.

Journal of Pediatric Surgery
|October 31, 2008
PubMed

Insights

Early laparoscopic fundoplication and gastrostomy in infants with Spinal Muscular Atrophy (SMA) type I is safe, improving nutritional status and potentially reducing aspiration events. Further trials are needed to confirm long-term benefits.

Area of Science:

  • Pediatric Surgery
  • Neuromuscular Disorders
  • Gastroenterology

Background:

  • Spinal muscular atrophy (SMA) type I causes progressive muscle weakness, leading to dysphagia, aspiration, and mortality in children.
  • Infants with SMA type I often require nutritional and respiratory support due to swallowing difficulties.

Purpose of the Study:

  • To evaluate the safety and efficacy of early laparoscopic fundoplication and gastrostomy in infants with SMA type I.
  • To assess the impact of this surgical intervention on aspiration events and nutritional status.

Main Methods:

  • A cohort of 12 infants diagnosed with SMA type I underwent laparoscopic Nissen fundoplication with gastrostomy.
  • Standardized postoperative respiratory management and discharge criteria were implemented.
  • Outcomes including complication rates, feeding tolerance, length of stay, nutritional status, and respiratory hospitalizations were analyzed.

Main Results:

  • The procedure was performed safely with no significant complications and immediate postoperative extubation.
  • Patients experienced rapid return to full feeding and short inpatient stays.
  • Mean weight-for-length percentile significantly improved (doubled) at 1 year post-surgery (P = .03).
  • A nearly 50% decrease in respiratory-related hospitalizations was observed, though not statistically significant in this small cohort.

Conclusions:

  • Early laparoscopic fundoplication and gastrostomy is a safe intervention for infants with SMA type I.
  • The procedure is associated with improved nutritional status and a trend towards reduced aspiration-related events.
  • Larger prospective trials are recommended to confirm long-term benefits and compare with other nutritional support methods.
Abstract

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