A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Nutrition

Background:

• Children with severe neurological deficits often require feeding tube access and antireflux procedures.
• Fundoplication, a common antireflux procedure, has high complication and failure rates (40-50%) in this population.

Purpose of the Study:

• To evaluate the efficacy and complications of Roux-en-Y jejunostomy for feeding access in neurologically impaired children.
• To assess its utility as an alternative to fundoplication, especially after failed antireflux procedures.

Main Methods:

• A retrospective review of 12 Roux-en-Y jejunostomies performed over a 6-month period (December 1993).
• All patients had documented gastroesophageal reflux; one had a prior failed Nissen fundoplication.
• Postoperative follow-up was conducted for 12 months.

Main Results:

• No deaths occurred. One patient needed stoma revision for prolapse; another required reoperation for tube dislodgement.
• Eight of the 12 patients experienced jejunostomy tube plugging or dislodgement, necessitating outpatient procedures for correction.
• No significant oral feeding was achieved in these patients.

Conclusions:

• Roux-en-Y jejunostomy can be a beneficial option for neurologically impaired children unable to ingest significant calories orally.
• It may serve as a useful alternative following failed fundoplication.
• Jejunostomy tube plugging and dislodgement are the primary postoperative concerns, often requiring radiographic confirmation for tube repositioning.