title: Impact of laparoscopic anterior 270 degrees fundoplication on the quality of life and symptoms profile of neurodevelopmentally delayed versus neurologically unimpaired children and their parents.
abstract: BACKGROUND
  This prospective study investigated the therapy-induced changes in the quality of life (QoL) experienced by neurologically healthy and neurodevelopmentally delayed children and their parents after laparoscopic anterior 270 degrees fundoplication (LAF).
  
  
  METHODS
  In this study, 40 patients (21 impaired) with a mean age of 7.8 years underwent LAF for gastroesophageal reflux disease (GERD) and were evaluated before surgery and then 3 and 6 months afterward using the Gastrointestinal Quality-of-Life Index (GIQLI) supplemented by conventional symptom markers.
  
  
  RESULTS
  Growth, proton pump inhibitor use, and frequency of supraesophageal/respiratory symptoms improved significantly (p < 0.001) as did feeding parameters (p < 0.05). The global GIQLI score improved by 49 +/- 21% (p < 0.001). The greatest improvement occurred in the symptoms domain (p < 0.001). However, positive alterations also were found in the dimensions of emotions (58%), social functions (37%) and physical functions (27%) (p < 0.001). Comparison of the overall benefit did not show any differences between the subgroups of neurologically fit and impaired children. However, for the child-centered symptoms domain, the benefit increased stepwise with the degree of impairment. This was counterbalanced by an inverse relationship for the parent-centered emotions domain (p < 0.05).
  
  
  CONCLUSIONS
  Besides the known improvement in symptoms, LAF achieves a significant improvement in QoL for children and their parents. There is no overall difference in the benefit experienced by neurologically impaired and healthy children.
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, 30625 Hannover, Germany. ceng@bdc.de
authors.forename: Carsten
authors.initials: C
authors.lastname: Engelmann
authors.forename: Stella
authors.initials: S
authors.lastname: Gritsa
authors.forename: Benno Manfred
authors.initials: BM
authors.lastname: Ure
mesh_terms: D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000150:complications* / Q000523:psychology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000523:psychology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000150:complications* / Q000523:psychology; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome