Can laparoscopic antireflux surgery improve the quality of life in children with neurologic and neuromuscular handicaps?
OBJECTIVE
Children with neurologic and neuromuscular handicaps frequently have various symptoms related to gastroesophageal reflux (GER) disease. The long-term efficacy of antireflux surgery remains controversial in such children with GER. The clinical results of such patients who underwent laparoscopic fundoplication were examined in the current study.


METHODS
Between 1997 and 2003, laparoscopic fundoplication was performed in 56 handicapped children (mean age, 6 years), and gastrostomy was performed concurrently in 52. The main symptoms were emesis/hematemesis in 40 and respiratory symptoms, including repeated respiratory infection and distress, in 31.


RESULTS
There were no severe postoperative complications or operative mortality. Emesis/hematemesis was controlled adequately in those without recurrence. Respiratory symptoms were controlled unsuccessfully in 16 patients (52%), 8 of whom required further respiratory care including nasal airway tube, tracheostomy, and laryngotracheal separation. Recurrence of GER disease occurred in 10 patients, 7 of whom underwent a second Nissen fundoplication successfully. Thirteen died within the median follow-up period of 14 months.


CONCLUSIONS
Laparoscopic fundoplication is effective in controlling emesis/hematemesis, but its efficacy is limited in terms of respiratory problems in handicapped children. Further refinements in diagnostic and treatment strategies are mandatory to improve the quality of life in such patients.
Kawahara
Hisayoshi
H
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Okuyama
Hiroomi
H
Kubota
Akio
A
Oue
Takaharu
T
Tazuke
Yuko
Y
Yagi
Makoto
M
Okada
Akira
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D009468:Neuromuscular Diseases / Q000150:complications; D011788:Quality of Life