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Prophylactic anti-reflux procedure for children undergoing laparoscopic gastrostomy: Rethinking of the routine

Adrian Chi Heng Fung1, Yu Ning Ooi1, Ho Ming Hui1

  • 1Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong.

World Journal of Surgery
|March 19, 2024
PubMed

Insights

Prophylactic anti-reflux surgery during laparoscopic gastrostomy in children is not routinely necessary. A pre-operative pH study helps identify patients who may benefit, avoiding longer operative times and higher conversion rates associated with unnecessary anti-reflux procedures.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Outcomes

Background:

  • Laparoscopic gastrostomy is common for pediatric enteral nutrition.
  • The necessity of prophylactic anti-reflux surgery during gastrostomy is debated.

Purpose of the Study:

  • To assess the role and impact of prophylactic anti-reflux surgery in children undergoing laparoscopic gastrostomy.

Main Methods:

  • Retrospective analysis of 79 children without pre-existing reflux undergoing laparoscopic gastrostomy.
  • Comparison of outcomes between gastrostomy alone and gastrostomy with prophylactic anti-reflux surgery groups.

Main Results:

  • Prophylactic anti-reflux surgery group had longer operative times and higher conversion rates.
  • No major complications in either group.
  • De novo reflux occurred in 11.6% of the gastrostomy-alone group, managed conservatively.

Conclusions:

  • Routine prophylactic anti-reflux surgery is not indicated.
  • Pre-operative pH studies aid in selecting patients for anti-reflux procedures, preventing unnecessary interventions.
  • Low rates of de novo reflux after gastrostomy can be managed without surgery.
Abstract

Keywords:
childrengastroesophageal refluxgastrostomyminimally invasive surgery

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