Fundoplication in Children with Neurological Impairment: A Worthwhile Surgical Treatment?

Purpose: To review the treatment and outcome of children with neurological impairment (NI) undergoing fundoplication in a paediatric surgery centre. Methods: Records of children with NI undergoing fundoplication from 1996 to 2004 were reviewed regarding impact on feeding, nutrition, respiratory symptoms and operative technique. Results: Forty-six NI children underwent fundoplication with gastrostomy. Thirty-nine records were retrievable. Recurrent vomiting and aspiration-pneumonia were the dominant indications for operation. Nissen's wrap replaced partial wraps since 2002. Laparoscopic Nissen's became the procedure of choice since 2003. Post-operative complication rate was 53%. Mean follow-up was 25 months with 8% gastroeosphageal reflux disease recurrence and 13% mortality. Mean hospital-stay relating to pneumonia during the 6 months pre- and post-operation were 82 and 40 days respectively (p<0.001). Mean weight increased from 15th to 17th percentile. Conclusions: Reflux-related respiratory symptoms in the NI children were significantly improved by fundoplication. Co-morbidities contribute to post-operative complications, ongoing airway symptoms, failure-to-thrive and mortalities. Laparoscopic approach offers comparable outcome.