title: Gastrointestinal tract feeding access and the role of fundoplication in combination with gastrostomy.
abstract: OBJECTIVE
  Feeding access and associated antireflux procedures continue to be some of the most common operations performed in pediatric patients. This review will discuss the various feeding access procedures available, including minimally invasive techniques, and further elaborate on appropriate indications for a concurrent antireflux procedure as well as alternatives to fundoplication.
  
  
  RESULTS
  Gastrostomy and jejunostomy can be successfully placed using endoscopic or laparoscopic techniques with low complication rates. Nissen fundoplication is well described laparoscopically but failure with recurrent gastroesophageal reflux has resulted in the development of other operative alternatives.
  
  
  CONCLUSIONS
  Decisions concerning appropriate long-term feeding access must be individualized, understanding the advantages and disadvantages of gastrostomy and jejunostomy techniques. Laparoscopic Nissen fundoplication is successful for treatment of patients who fail medical therapy of gastroesophageal reflux, but recurrent gastroesophageal reflux is a persistent problem that requires innovative solutions.
authors.affiliation: University of Colorado Health Sciences Center, and Department of Pediatric Surgery, The Children's Hospital, 1056 East 19th Avenue, Denver, CO 80218, USA. partrick.david@tchden.org
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
mesh_terms: D002648:Child; D004724:Endoscopy; D004750:Enteral Nutrition; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*