Risks and benefits of surgical management of gastroesophageal reflux in neurologically impaired children.
BACKGROUND
The aim of this study was to investigate the feasibility and results of laparoscopic antireflux procedure in neurologically impaired children.


METHODS
Over a 5-yr period, 259 children affected by gastroesophageal reflux disease underwent laparoscopic antireflux procedure. Eighty of them (30.8%) were neurologically impaired. In 58 children we performed an anterior fundoplication according to Thal and in 22 patients a 360 degrees fundoplication according to Nissen. Forty-eight children underwent an associated gastrostomy placement at the same time as the laparoscopic antireflux procedure.


RESULTS
We recorded 4/80 intraoperative complications; in all cases the complication was managed laparoscopically and no conversion was needed. Follow-up ranged from 6 months to 6 yrs (median 3 yrs). We recorded 24/80 postoperative complications, 5 of which required a redo procedure. We have a mortality rate of 17.5% but in only one case was the event related to the antireflux procedure.


CONCLUSIONS
Laparoscopic fundoplication can be performed safely and with acceptable results in neurologically impaired children. The indication to add a gastrostomy should be tailored to the needs of the individual patient. Mortality rate in neurologically impaired children patients with gastroesophageal reflux disease is high but in most cases unrelated to the antireflux procedure.
Esposito
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C
Department of Experimental and Clinical Medicine, Magna Graecia University, Via Tommaso Campanella 115, 88100 Catanzaro, Italy. ciroesp2@unicz.it
Van Der Zee
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DC
Settimi
A
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Doldo
P
P
Staiano
A
A
Bax
N M A
NM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D009422:Nervous System Diseases / Q000150:complications* / Q000601:surgery; D009748:Nutrition Disorders / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D013995:Time