Antireflux surgery in children with neurological impairment:  caregiver perceptions and complications.
OBJECTIVE
The aim of the present study was to report caregiver perceptions to antireflux surgery and gastrostomy in children with severe neurological impairment and to report the complications of the surgery.


METHODS
Children were identified from a clinic database and clinical information and surgical complications were extracted from the database and hospital medical records. A cross-sectional questionnaire addressing severity of symptoms was administered to parents/caregivers and scored with a 5-point Likert scale (1 is much better to 5, much worse).


RESULTS
A total of 122 children, median age 74 months (interquartile range 29-124), 63% spastic quadriplegic cerebral palsy, had antireflux surgery. Laparoscopic surgery was performed in 77 of 122 (63%) and 117 of 122 (96%) had gastrostomy insertion. Questionnaire was completed by 89 of 122 (73%) children; median duration of time from fundoplication to questionnaire was 77 months (43-89). The majority of caregivers indicated that surgery improved or greatly improved weight gain, chest infections, vomiting, and feeding tolerance. Only 2 caregivers reported that they regretted consenting to surgery. Serious surgical complications occurred in 10%.


CONCLUSIONS
Serious complications were uncommon in this series of antireflux surgery in neurologically impaired children. Although gagging and retching were common following surgery, a high percentage of caregivers reported improved nutrition, reflux-related symptoms, and high levels of satisfaction.
Department of Gastroenterology, Children's Hospital at Westmead, Sydney, Australia.
Edward V
EV
O'Loughlin
Helen
H
Somerville
Albert
A
Shun
Rachel
R
Gangemi
Erik
E
La Hei
Aniruddh
A
Desphande
Timothy F
TF
O'Loughlin
D017028:Caregivers; D002547:Cerebral Palsy / Q000601:surgery; D002648:Child; D003430:Cross-Sectional Studies; D004435:Eating; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D010535:Laparoscopy; D009422:Nervous System Diseases / Q000150:complications*; D010290:Parents; D017060:Patient Satisfaction; D010465:Perception; D011183:Postoperative Complications; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014839:Vomiting