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Is fundoplication mandatory in children with neurological impairment undergoing gastrostomy?

Yael Dreznik1,2, Artur Baazov1,2, Nadav Dvir1,2

  • 1Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqva, Israel.

Journal of Paediatrics and Child Health
|October 11, 2021
PubMed

Insights

Fundoplication with gastrostomy in children with neurological impairment (NI) is not always necessary. For NI patients with refractory seizures, fundoplication showed no significant improvement in gastro-oesophageal reflux disease symptoms.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neurology

Background:

  • Percutaneous endoscopic gastrostomy (PEG) and surgical gastrostomy (SG) are common for children with neurological impairment (NI) and swallowing difficulties.
  • Pulmonary aspiration is a significant concern in these patients.
  • The role of concomitant or delayed fundoplication alongside gastrostomy in NI patients remains debated.

Purpose of the Study:

  • To review the experience with fundoplication performed concomitantly with gastrostomy or later in pediatric patients.
  • To evaluate patient outcomes, particularly in those with neurological impairment.

Main Methods:

  • A retrospective cohort study was conducted.
  • Data from pediatric patients who underwent SG or PEG with or without Nissen fundoplication between 2007 and 2018 were analyzed.

Main Results:

  • Out of 345 patients undergoing PEG/SG, 89 had fundoplication; 158 patients (45.8%) had NI.
  • Most fundoplication patients (77.5%) had NI.
  • NI patients with refractory seizures showed minimal improvement in gastro-oesophageal reflux disease (GERD) symptoms post-fundoplication compared to NI patients without refractory seizures.

Conclusions:

  • Concomitant fundoplication is not mandatory for NI patients.
  • Fundoplication is not efficacious in preventing GERD in NI patients with refractory seizures.
Abstract

Keywords:
fundoplicationgastrostomyneurologically impaired

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