title: A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child.
abstract: OBJECTIVE
  Feeding tube access with an antireflux procedure is frequently necessary in children with severe neurological deficits. Fundoplication in this particular group of patients has many complications and a reported failure rate of 40% to 50%. Recently, the use of a feeding Roux-en-Y jejunostomy has been advocated in this population.
  
  
  METHODS
  Since December 1993, over a 6-month period, the authors performed 12 Roux-en-Y jejunostomies. All children had documented gastroesophageal reflux. One patient had a prior failed Nissen fundoplication, and none of these patients were feeding significantly by mouth. Postoperative follow-up has been 12 months.
  
  
  RESULTS
  There were no deaths in this series. One patient required early revision of the stoma because of marked prolapse. One 11-month-old infant required reoperation 7 days postoperatively because of tube dislodgment. Eight of the 12 patients required out-patient procedures to unplug or replace the jejunostomy tube.
  
  
  CONCLUSIONS
  The operation may be beneficial in a subset of neurologically impaired children who will never be able to ingest significant calories by mouth. It may also be useful after a failed fundoplication. The main postoperative complications were plugging and dislodgment of the jejunostomy tube, which if they occurred early, required x-ray confirmation for catheter placement.
authors.affiliation: Division of Pediatric Surgery, Brown University School of Medicine, Providence, RI 02903, USA.
authors.forename: B F
authors.initials: BF
authors.lastname: Gilchrist
authors.forename: F I
authors.initials: FI
authors.lastname: Luks
authors.forename: F G
authors.initials: FG
authors.lastname: DeLuca
authors.forename: C W
authors.initials: CW
authors.lastname: Wesselhoeft
mesh_terms: D000713:Anastomosis, Roux-en-Y; D004750:Enteral Nutrition; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D011183:Postoperative Complications; D012086:Reoperation