title: Feeding gastrostomy in children with complex heart disease: when is a fundoplication indicated?
abstract: OBJECTIVE
  Malnutrition is common among children with complex heart disease (CHD). Feeding gastrostomies are often used to improve the nutritional status of such patients. Our purpose was to evaluate a cohort of children with CHD following open Stamm gastrostomy without fundoplication.
  
  
  METHODS
  We reviewed all CHD patients who underwent feeding gastrostomy placement from 1/1/2004 to 4/7/2015. Demographic data, cardiac diagnoses, operative details, post-operative complications, and the need for GJ feeding and fundoplication were examined.
  
  
  RESULTS
  Open Stamm gastrostomy was performed in 111 patients. Median age at surgery was 37 weeks (3 weeks-13.7 years); average weight was 5.3 ± 4.9 kg. Thirty-four patients (30 %) experienced a total of 37 minor complications, including tube dislodgement after stoma maturation (20), superficial surgical site infection (13), mechanical failure (3), and bleeding (1). Three patients experienced a major complication (need for return to the OR or peri-operative death <30 days). Three patients required a subsequent fundoplication. Fifty-six surviving patients (62 %) continue gastrostomy feeds, of which 7 (13 %) patients require GJ feeds.
  
  
  CONCLUSIONS
  Children with CHD tolerate an open Stamm gastrostomy well with minimal major complications. These results support very selective use of fundoplication in infants and children with CHD who require a feeding gastrostomy.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Carpenter
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Soeken
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA.
authors.forename: Alfred J
authors.initials: AJ
authors.lastname: Correa
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA.
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Kissler
authors.affiliation: Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr., Houston, TX, 77030, USA.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX, 77030, USA. dewesson@texaschildrens.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Wesson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications*; D005774:Gastrostomy / Q000379:methods*; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies
keywords: Congenital heart disease; Fundoplication; Gastroesophageal reflux; Gastrostomy