Is prophylactic fundoplication necessary? Laparoscopic fundoplication after gastrostomy vs non-gastrostomy patients

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Device Procedures

Background:

• Laparoscopic fundoplication is a common treatment for gastroesophageal reflux disease (GERD).
• Children with severe motor and intellectual disabilities (SMID) often require both gastrostomy for nutrition and fundoplication for GERD.
• The benefit of prophylactic fundoplication during gastrostomy is debated due to potential complications and low subsequent need.

Purpose of the Study:

• To compare the safety and outcomes of fundoplication performed after gastrostomy versus primary fundoplication in pediatric patients.
• To evaluate the necessity of routine prophylactic fundoplication in children with SMID undergoing gastrostomy.

Main Methods:

• Retrospective analysis of 47 fundoplication cases at Tsukuba University Hospital (2013-2024).
• Comparison between patients who underwent fundoplication after gastrostomy (post-G group) and those who had primary fundoplication.
• Outcomes assessed included operative time, blood loss, hospital stay, need for open conversion, and complication rates.

Main Results:

• No significant differences in operative time, blood loss, or post-operative hospital stay between the post-G and primary fundoplication groups.
• No cases required conversion to open surgery.
• The post-operative complication rate was not significantly different between the two groups.

Conclusions:

• Fundoplication can be safely performed after gastrostomy without increased surgical risks, contrary to concerns about adhesions or operative difficulties.
• There is no established direct link between gastrostomy and GERD progression.
• Routine prophylactic fundoplication is not indicated due to the low incidence of GERD requiring this procedure after gastrostomy.