Early laparoscopic fundoplication and gastrostomy in infants with spinal muscular atrophy type I.
OBJECTIVE
Spinal muscular atrophy (SMA) in children leads to progressive muscle weakness, dysphagia, aspiration, and death. We hypothesized that early laparoscopic fundoplication and gastrostomy in infants with SMA type I could be performed safely perhaps leading to fewer aspiration events and improved nutritional status.


METHODS
Children diagnosed with SMA type I from 2002 through 2005 were included (n = 12). All children underwent laparoscopic Nissen fundoplication with gastrostomy shortly after diagnosis. Postoperative respiratory management and discharge criteria were standardized.


RESULTS
All patients were extubated immediately postoperatively. There were no significant complications. Average time to full feeding and inpatient length of stay were 42 +/- 4.9 hours (range, 30-48 hours) and 78 +/- 22.5 hours (range, 44-120 hours), respectively. Mean weight-for-length percentile was doubled at 1 year postoperatively (P = .03). The number of respiratory-related hospitalizations in the cohort decreased by almost 50% in the ensuing 12 months after surgery, although this did not reach statistical significance in this small cohort (P = .34).


CONCLUSIONS
Early laparoscopic fundoplication and gastrostomy is safe and is associated with improved nutritional status. A trend toward fewer significant long-term aspiration-related events was seen after fundoplication. To better assess the long-term benefits of performing an antireflux procedure in these high-risk patients, a larger prospective trial comparing current nutritional support practices is needed.
Durkin
Emily T
ET
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-7375, USA.
Schroth
Mary K
MK
Helin
Margaret
M
Shaaban
Aimen F
AF
D015331:Cohort Studies; D004750:Enteral Nutrition; D005260:Female; D018662:Fundoplication / Q000379:methods* / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D019060:Minimally Invasive Surgical Procedures; D010348:Patient Care Team; D011182:Postoperative Care; D011183:Postoperative Complications; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D014897:Spinal Muscular Atrophies of Childhood / Q000150:complications / Q000601:surgery*