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Routine anti-reflux surgery combined with gastrostomy in children: is it really necessary? Our single-center
P Guillén Redondo1, R Espinosa Góngora1, A L Luis Huertas1
1Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain).
Insights
Routine anti-reflux surgery with gastrostomy is not always necessary for pediatric patients. Individualized fundoplication may be considered if medical treatments fail, but further research is needed to identify optimal candidates.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes
Background:
- Gastroesophageal reflux (GER) is a common concern in children requiring gastrostomy.
- Understanding the incidence and management of GER in this population is crucial for improving patient care.
Purpose of the Study:
- To investigate the prevalence and outcomes of gastroesophageal reflux in pediatric patients undergoing gastrostomy.
- To evaluate the efficacy of combined anti-reflux surgery with gastrostomy versus gastrostomy alone.
Main Methods:
- A retrospective analysis of 207 pediatric patients who underwent gastrostomy between 2000 and 2017.
- GER was defined by clinical signs necessitating antisecretory, prokinetic treatment, or anti-reflux surgery.
- Data collected included demographics, clinical characteristics, progression, and complications.
Main Results:
- Of 207 patients, 46% had pre-existing GER symptoms. Combined gastrostomy and fundoplication in 41 patients led to worsening GER in 6 (14.6%).
- In 55 patients with pre-existing GER undergoing gastrostomy alone, symptoms resolved or improved in 64%, but worsened in 36%, requiring fundoplication in 10.
- In patients without prior GER (111), new symptoms developed post-gastrostomy in 16%, with only 2 requiring fundoplication.
Conclusions:
- Routine anti-reflux surgery concurrent with gastrostomy is not routinely indicated in pediatric patients.
- Fundoplication should be individualized and considered for patients with refractory GER symptoms after medical management failure.
- Further research is needed to define specific patient subgroups that would benefit from combined procedures.
Objective:
To study gastroesophageal reflux (GER) in children undergoing gastrostomy in a single pediatric institution.
Material And Methods:
A retrospective study of patients undergoing gastrostomy from 2000 to 2017 was carried out. Demographic data, clinical data, progression, and complications were recorded. GER was considered positive in patients with clinical signs requiring antisecretory treatment, prokinetic treatment, or anti-reflux surgery to control symptoms.
Results:
207 patients with a median age of 2 years [R: 0.25-18] were included. Neurological impairment was the most frequent underlying condition (74%). Swallowing difficulty and undernourishment were the main surgical indications for gastrostomy. Prior to gastrostomy, 96 out of 207 patients (46%) showed GER symptoms. Combined fundoplication and gastrostomy was performed in 41 (43%) patients with preexisting GER, 6 of whom showed GER worsening (4 required redo fundoplication). 5 complications following fundoplication were noted - gastric perforation, sustained Dumping syndrome, and gastroesophageal stenosis. 55 out of 96 (57%) patients with preexisting GER underwent gastrostomy alone. Clinical signs disappeared in 16 of them (29%) and improved or stabilized in 19 (35%). GER worsening occurred in 20 patients (36%), with subsequent fundoplication being required in 10 cases. In patients with no previous clinical signs (111 out of 207), GER symptoms occurred following gastrostomy in just 18 cases (16%), and only 2 patients required fundoplication.
Conclusions:
In our experience, routine anti-reflux surgery combined with gastrostomy is not justified. Individualized fundoplication should be considered in case of medical treatment failure. Further studies with an adequate design are required to establish which patients could really benefit from this procedure.
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