title: Simple fundoplication versus additional vagotomy and pyloroplasty in neurologically impaired children--a single centre experience.
abstract: OBJECTIVE
  Gastrooesophageal reflux disease (GERD) is a significant problem in children with neurological impairment (NI) with high failure rates for fundoplication. Fundoplication with vagotomy and pyloroplasty (FVP) can improve the outcome by altering the sensory or motor dysfunction associated with the reflux. We report our comparative outcomes for simple fundoplication (SF) and FVP in NI children.
  
  
  METHODS
  Case records of all patients having fundoplication under a single consultant at a tertiary UK paediatric surgical centre between January 1997 and December 2012 were retrospectively assessed for recurrent symptoms and redo surgery. The data were collected using a Microsoft Excel database and analysed on Graphpad prism software program. Data are median (range). P value<0.05 was considered significant.
  
  
  RESULTS
  Data were available for 244 out of 275 patients who underwent fundoplication during this period (157 SF and 87 FVP). Neurological disease or known syndromes were recorded in 158 patients. Thirty-five children had congenital anatomical abnormalities. Laparoscopic fundoplication was done in 37 cases. Revisional surgery for recurrent symptoms was performed in 22 patients. In the neurologically normal children, all of whom had SF, the revision rate was 6.5%. In the NI children the revision rates were 18.5% for SF and 3.9% for FVP, respectively (Fisher's exact, P<0.05). The median time to redo surgery was 10 (1-63) months, and the median time to follow up was 19.5 (2-177) months.
  
  
  CONCLUSIONS
  There appears to be a significantly lower need for redo surgery following FVP than SF in children with NI.
authors: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
authors: J Fraser
authors: JF
authors: Horwood
authors: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
authors: William
authors: W
authors: Calvert
authors: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
authors: Dhanya
authors: D
authors: Mullassery
authors: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
authors: Mohammed
authors: M
authors: Bader
authors: Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK. Electronic address: matthew.jones@alderhey.nhs.uk.
authors: Matthew O
authors: MO
authors: Jones
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D011708:Pylorus / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D015167:Vagotomy, Truncal / Q000379:methods*
keywords: Gastrooesophageal reflux disease; Neurological impaired, fundoplication; Vagotomy and pyloroplasty, children