title: Fundoplication with gastrostomy vs gastrostomy alone: a systematic review and meta-analysis of outcomes and complications.
abstract: OBJECTIVE
  We compare the outcomes of fundoplication with gastrostomy vs gastrostomy alone and review the need for subsequent fundoplication after the initial gastrostomy alone.
  
  
  METHODS
  We searched studies published from 1969 to 2016 for comparative outcomes of concomitant fundoplication with gastrostomy (FGT) vs gastrostomy insertion alone (GT) in children. Gastrostomy methods included open, laparoscopic, and endoscopic procedures. Primary aims were minor and major complications. Secondary aims included post-operative reflux-related complications, fundoplication specific complications, and need for subsequent fundoplication after GT.
  
  
  RESULTS
  We reviewed 447 studies; 6 observational studies were included for meta-analysis, encompassing 2730 children undergoing GT (n = 1745) or FGT (n = 985). FGT was associated with more minor complications [19.9 vs 11.4%, OR 2.02, 95% confidence interval (CI) 1.43-2.87, p ≤ 0.0001, I2= 0%], minor complications requiring revision (6.8 vs 3.0%, OR 2.27, 95% CI 1.28-4.05, p = 0.005, I2= 0%), and more overall complications (21.3 vs 12.0%, OR 1.99, 95% CI 1.43-2.78, p < 0.0001, I2= 0%). Incidence of major complications (1.8 vs 2.0%, OR 1.39, 95% CI 0.62-3.11, p = 0.42, I2= 5%) and reflux-related complications (8.8 vs 10.3%, OR 0.75, 95% CI 0.35-1.68, p = 0.46, I2= 0%) in both groups was similar. Incidence of subsequent fundoplication in GT patients was 8.6% (mean).
  
  
  CONCLUSIONS
  Gastrostomy alone is associated with fewer minor and overall complications. Concomitant fundoplication does not significantly reduce reflux-related complications. As few patients require fundoplication after gastrostomy, current evidence does not support concomitant fundoplication.
authors.affiliation: Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Brendan K Y
authors.initials: BK
authors.lastname: Yap
authors.affiliation: Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Shireen Anne
authors.initials: SA
authors.lastname: Nah
authors.affiliation: Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. low.yee@singhealth.com.sg.
authors.forename: Yee
authors.initials: Y
authors.lastname: Low
mesh_terms: D000293:Adolescent; D002648:Child; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
keywords: Complications; Fundoplication; Gastrostomy; Meta-analysis; Reflux