A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child.
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.
Gilchrist
B F
BF
Division of Pediatric Surgery, Brown University School of Medicine, Providence, RI 02903, USA.
Luks
F I
FI
DeLuca
F G
FG
Wesselhoeft
C W
CW
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