title: Retching and vomiting in neurologically impaired children after fundoplication: predictive preoperative factors.
abstract: OBJECTIVE
  In neurologically impaired children, retching and recurrent vomiting are common after Nissen fundoplication. The aim of this study was to identify whether there are preoperative factors that predict their occurrence.
  
  
  METHODS
  Twenty neurologically impaired children (8 boys, 12 girls; age range, 3 months to 8 years) were studied prospectively by taking a detailed history of behaviors and symptoms associated with feeding before and after Nissen fundoplication for gastroesophageal reflux.
  
  
  RESULTS
  Preoperatively, children could be classified into 2 groups. Children in group A had symptoms suggestive of only gastroesophageal reflux (effortless "vomiting" or regurgitation), whereas children in group B exhibited one or more features associated with activation of the emetic reflex (pallor, sweating, retching, forceful vomiting). Postoperatively 0 of 8 in group A retched compared with 8 of 12 in group B (P <.005, Fishers Exact test).
  
  
  CONCLUSIONS
  Children at high risk of retching, and ultimately vomiting, after antireflux surgery may be identified clinically preoperatively. They have symptoms that are specifically caused by activation of the emetic reflex rather than to gastroesophageal reflux. In these cases, antireflux surgery could be considered inappropriate and hence be avoided.
authors.affiliation: Department of Surgery, Institute of Child Health, London, England.
authors.forename: C A
authors.initials: CA
authors.lastname: Richards
authors.forename: P J
authors.initials: PJ
authors.lastname: Milla
authors.forename: P L
authors.initials: PL
authors.lastname: Andrews
authors.forename: L
authors.initials: L
authors.lastname: Spitz
mesh_terms: D002493:Central Nervous System Diseases / Q000150:complications / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome