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Risks and benefits of antireflux operations in neurologically impaired children
E S Borgstein1, H A Heij, J D Beugelaar
1Paediatric Surgical Centre Amsterdam, The Netherlands.
Insights
Anterior gastropexy surgery for gastro-oesophageal reflux (GER) in neurologically impaired children can improve quality of life but carries significant risks. Complications and re-operations are common, though the procedure is successful in most survivors.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Background:
- Gastro-oesophageal reflux (GER) presents significant feeding challenges and complications like oesophagitis in neurologically impaired children.
- Medical treatments for GER in this population are often ineffective, necessitating surgical intervention.
Purpose of the Study:
- To evaluate the efficacy and safety of anterior gastropexy as an anti-reflux operation in neurologically impaired children.
- To assess the complication rates and long-term outcomes of this surgical approach.
Main Methods:
- A retrospective study of 50 neurologically impaired children who underwent anterior gastropexy between 1976 and 1992.
- Gastrostomy was combined in 23 patients.
- Follow-up included assessment of operative mortality, early and late complications, re-operations, and overall success rate.
Main Results:
- No operative mortality was recorded.
- 14 patients experienced 25 early complications, and 9 patients had 9 late complications.
- Twelve patients required 17 re-operations for various issues including delayed gastric emptying, intestinal obstruction, and recurrent GER. Nine patients died during follow-up, with two deaths attributed to the surgery. Among 41 survivors, 35 had a successful outcome.
Conclusions:
- Antireflux operations like anterior gastropexy in neurologically impaired children are associated with a high risk of complications.
- Preoperative identification of risk factors for complications is not feasible.
- Despite the risks, the improvements in quality of life for the majority of patients may justify the procedure.
Abstract:
Gastro-oesophageal reflux (GER) in neurologically impaired children often causes feeding problems and complications of oesophagitis and is frequently resistant to medical treatment. Fifty neurologically impaired children underwent anterior gastropexy as anti-reflux operation, combined with gastrostomy in 23, between 1976 and 1992. There was no operative mortality. There were 25 early complications in 14 patients and 9 late complications in 9 patients. Twelve patients needed 17 re-operations for delayed gastric emptying [4], intestinal obstruction [3], para-oesophageal hernia [3], oesophageal stenosis [4], and recurrent GER, revision of gastrostomy, subphrenic abscess (one each). Nine patients died during the follow up period. Death in two children was related to the operation (incarcerated para-oesophageal hernia and blow-out of the stomach). Out of 41 survivors, the operation was judged successful in 35. It is concluded that antireflux operations in neurologically impaired children carry a high risk of complications. Preoperative identification of risk factors is not possible. The improvements in the quality of life achieved in the majority of patients outweigh the risks.
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