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Is prophylactic fundoplication necessary in neurologically impaired children?
N Viswanath1, D Wong, D Channappa
1Waikato Hospital, Department of Paediatric Surgery, Hamilton, New Zealand.
Summary
Prophylactic fundoplication is not necessary for neurologically impaired children needing gastrostomy tubes. Performing fundoplication alongside gastrostomy increases complications; selective surgery for reflux symptoms is recommended.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Neurology
Background:
- Gastrostomy tube placement is common in neurologically impaired children.
- Antireflux surgery (fundoplication) was previously routine but increased complications.
- Current practice selectively offers fundoplication based on reflux indications.
Purpose of the Study:
- To evaluate the necessity of prophylactic fundoplication in neurologically impaired children undergoing gastrostomy.
- To compare complication rates between gastrostomy alone and gastrostomy with concomitant fundoplication.
Main Methods:
- Retrospective comparison of children undergoing gastrostomy with or without fundoplication (1996-2007).
- Recorded clinical data, indications, and follow-up for gastroesophageal reflux symptoms.
- Analyzed and statistically compared surgical complication rates.
Main Results:
- 137 children had gastrostomy; 60 underwent fundoplication.
- Subsequent fundoplication was needed in only 17.1% of children with gastrostomy alone.
- Gastrostomy with fundoplication had significantly higher complication rates (p=0.036).
Conclusions:
- Prophylactic fundoplication is not indicated for neurologically impaired children receiving gastrostomy.
- Selective fundoplication for persistent reflux symptoms reduces postoperative morbidity.
- Laparoscopic approach can manage technical challenges in later fundoplication.
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