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Evaluation of Nissen fundoplication in neurologically impaired children
H Rice1, J H Seashore, R J Touloukian
1Section of Pediatric Surgery, Yale University School of Medicine, New Haven, CT 06510.
Insights
Nissen fundoplication in neurologically impaired children with gastroesophageal reflux (GER) safely reduces hospitalizations and improves short-term weight gain. Symptomatic relief is comparable to non-impaired children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Background:
- Nissen fundoplication for gastroesophageal reflux (GER) is controversial in neurologically impaired children.
- Evaluating the benefits in this specific population is crucial for clinical decision-making.
Purpose of the Study:
- To assess the efficacy and safety of Nissen fundoplication in neurologically impaired children with GER.
- To compare outcomes between neurologically impaired and unimpaired children undergoing the procedure.
Main Methods:
- Retrospective review of hospital records for 77 children (52 neurologically impaired, 25 unimpaired) who underwent Nissen fundoplication for GER.
- Analysis of hospital admissions, hospitalization days, weight gain (especially for failure to thrive - FTT), and symptomatic relief pre- and post-operatively.
Main Results:
- Neurologically impaired children showed significantly fewer hospital admissions and days hospitalized in the first 6 months post-surgery.
- Impaired children with preoperative failure to thrive experienced significantly increased weight gain in the first 6 months post-surgery.
- Symptomatic relief was similar in both groups, but perioperative mortality was 6% in impaired children versus 0% in unimpaired children.
Conclusions:
- Nissen fundoplication is a safe and beneficial procedure for neurologically impaired children with GER.
- The surgery effectively reduces hospitalizations and improves short-term weight gain in this vulnerable population.
- While safe, careful consideration of perioperative risks is warranted for impaired children.
Abstract:
The value of performing Nissen fundoplication in neurologically impaired children is a controversial issue. To evaluate the benefit of fundoplication in these children, hospital records were reviewed for 77 children who underwent fundoplication for gastroesophageal reflux (GER). Fifty-two children were neurologically impaired; 25 children had no neurological impairment. Impaired children had significantly fewer hospital admissions (1.8 v 0.7; P less than .005) and total days of hospitalization (36 v 14; P less than .005) during the first postoperative 6 months, compared with the immediate preoperative 6-month period. Normal children had fewer hospital admissions and days postoperatively, but the difference was not significant. Impaired children with preoperative failure to thrive (FTT had significantly increased average monthly weight gain over the first 6-month period postoperatively, compared with preoperative growth rate (3.0% v 0.9% of total body weight; P less than .05). Average monthly weight gain at 1 and 2 years postoperatively was not significantly different from preoperative values for impaired children. Growth rate of normal children with FTT did not change significantly postoperatively. Symptomatic relief was comparable in the normal and impaired children. Perioperative mortality was 0% in the normal children and 6% in the impaired children. This study demonstrates that Nissen fundoplication in neurologically impaired children with GER can be performed safely, reduces the frequency of hospitalization, and improves short-term weight gain.