Need for subsequent fundoplication after gastrostomy based on patient characteristics

Area of Science:

• Pediatric Surgery
• Gastroenterology

Background:

• Gastrostomy tube (GT) placement is common in pediatric patients.
• Many conditions requiring GTs are also associated with gastroesophageal reflux (GER).
• The risk of subsequent fundoplication in children without complicated reflux is not well-defined.

Purpose of the Study:

• To determine the disease-specific risk for fundoplication after gastrostomy tube placement in children.
• To identify patient variables and operative approaches influencing the need for subsequent fundoplication.

Main Methods:

• Retrospective review of 684 pediatric patients undergoing gastrostomy tube placement without fundoplication from 2000-2008 across two centers.
• Pearson's correlation and logistic regression analysis were used to evaluate predictors of subsequent fundoplication.
• Significance was set at P ≤ 0.01.

Main Results:

• 62 of 684 patients (9.1%) required subsequent fundoplication at a mean interval of 20.7 months.
• Cerebral palsy and anoxic brain injury were significantly correlated with and independent predictors of subsequent fundoplication.
• Laparoscopic gastrostomy tube placement showed a negative correlation with the need for fundoplication.

Conclusions:

• The low incidence of subsequent fundoplication supports a conservative approach in children without complicated reflux.
• Children with cerebral palsy and anoxic brain injury exhibit the highest risk for requiring fundoplication post-gastrostomy tube placement.