Fundoplication versus postoperative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy

Vernon‐Roberts, Angharad; Sullivan, Peter B.

doi:10.1002/14651858.cd006151.pub3

Cited by 32 publications

(14 citation statements)

References 37 publications

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“…Despite the lack of recommendations in the literature [19,20], in our institute, we routinely evaluate the presence of GERD and its severity through esophageal pH-monitoring before and after gastrostomy and perform fundoplication only if the reflux is symptomatic. Altogether, GERD involved half of the patients, a quarter of which were identified before placement and a quarter after placement, meaning that a routine fundoplication would result in 50% unneeded surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Gastrostomy Placement and Management in Children: A Single-Center Experience

et al. 2019

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BACKGROUND: To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series. METHODS: This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents’ opinion. RESULTS: Eighty-four gastrostomies were placed in total (35 F; 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients; late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux; five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile; the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube. CONCLUSION: This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive.

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Section: Discussionmentioning

confidence: 99%

Gastrostomy Placement and Management in Children: A Single-Center Experience

et al. 2019

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“…Esse é um método complementar que visualiza a função das estruturas anatômicas, seu funcionamento e direcionamento do bolo alimentar durante a mastigação e deglutição de consistências diferentes com contraste 46,47 . Uma das principais indicações desse exame é a suspeita de aspirações silenciosas 48,49 .…”

Section: Disfagiaunclassified

Digestive tract neural control and gastrointestinal disorders in cerebral palsy

Araújo¹,

Silva²,

Mendes³

2012

J Pediatr (Rio J)

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Objectives: To examine the neural control of digestive tract and describe the main gastrointestinal disorders in cerebral palsy (CP), with attention to the importance of early diagnosis to an efficient interdisciplinary treatment.Sources: Systematic review of literature from 1997 to 2012 from Medline, Lilacs, Scielo, and Cochrane Library databases. The study included 70 papers, such as relevant reviews, observational studies, controlled trials, and prevalence studies. Qualitative studies were excluded. The keywords used were: cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation, recurrent respiratory infections, and gastrostomy. Summary of the findings:The appropriate control of the digestive system depends on the healthy functioning and integrity of the neural system. Since CP patients have structural abnormalities of the central and peripheral nervous system, they are more likely to develop eating disorders. These range from neurological immaturity to interference in the mood and capacity of caregivers. The disease has, therefore, a multifactorial etiology. The most prevalent digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation, with consequent recurrent respiratory infections and deleterious impact on nutritional status. Conclusions:Patients with CP can have neurological abnormalities of digestive system control; therefore, digestive problems are common. The issues raised in the present study are essential for professionals within the interdisciplinary teams that treat patients with CP, concerning the importance of comprehensive anamnesis and clinical examination, such as detailed investigation of gastrointestinal disorders. Early detection of these digestive problems may lead to more efficient rehabilitation measures in order to improve patients' quality of life.J Pediatr (Rio J). 2012;88(6):455-64: Cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation. ResumoObjetivos: Abordar as peculiaridades do controle neuronal digestório e descrever as principais manifestações digestórias na paralisia cerebral, atentando-se à importância do diagnóstico precoce para intervenção interdisciplinar eficaz. Fontes dos dados:Revisão sistemática de 1997 a 2012 das bases de dados MEDLINE, LILACS, SciELO e Cochrane Library. Incluem-se 70 artigos, como revisões relevantes, estudos observacionais, ensaios clínicos e estudos de prevalência. Excluíram-se pesquisas qualitativas. Os termos pesquisados foram: paralisia cerebral, disfagia, doença do refluxo gastroesofágico, constipação intestinal, infecção respiratória e gastrostomia. Síntese dos dados:O controle adequado do trato digestório depende do funcionamento e integridade do sistema nervoso. Como indivíduos portadores de paralisia cerebral possuem anormalidades estruturais evidentes no sistema nervoso central e periférico, estão mais propensos a desenvolver distúrbios do trato digestório, com repercussões nutricionais. As alterações vão desde imaturidade neurológica até interferência do estado d...

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“…Prophylactic fundoplication with gastrostomy placement is still a controversial issue. 14 Although Kawahara et al 15 concluded, in their study, that gastroesophageal reflux and related symptoms rarely deteriorate to require additional treatment after gastrostomy placement in patients with NI, we are adopting the policy of prophylactic fundoplication with gastrostomy insertion in NI patients, in concordance with the study by Ponsky et al 16 …”

Section: Discussionmentioning

confidence: 77%

“…There is considerable uncertainty regarding the optimal treatment when faced with the decision of fundoplication surgery versus antireflux medications for children with GERD and NI who are undergoing gastrostomy insertion. 14 …”

Section: Discussionmentioning

confidence: 99%

Unilateral Versus Bilateral Wrap Crural Fixation in Laparoscopic Nissen Fundoplication for Children

Hassan

2014

JSLS

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Introduction:Gastroesophageal reflux (GERD) is common in neurologically impaired (NI) children. Fundoplication and gastrostomy have previously been indicated in NI children with GERD who have not responded to medical treatment. The most common reason for fundoplication failure is intrathoracic migration of the wrap.Objective:The aim of the study is to measure the effect of wrap fixation on the final outcome of laparoscopic Nissen fundoplication in NI children.Patients and Methods:A retrospective file review was conducted for all NI children who underwent laparoscopic Nissen fundoplication in 2 tertiary pediatric surgery centers in the United Arab Emirates from February 15, 2006 to February 15, 2013. Redo fundoplication patients were excluded from the study. Patients were divided into 2 groups: group 1 in which the fundoplication wrap was fixed to the right crus only, and group 2 in which the wrap was fixed to the right and left crus simultaneously.Results:The study population included 68 patients; there were 47 male and 21 female children. Mean age at time of surgery was 8.2 years. Recurrent GERD at 1 year postoperatively was 26% versus 7% in group 1 and group 2, respectively, by upper contrast study. Redo surgery was required in 21% versus 3% in group 1 and group 2, respectively.Conclusions:Bilateral fixation of the wrap to diaphragmatic crura significantly reduced recurrent GERD, in laparoscopic Nissen fundoplication for neurologically impaired children, with no increased risk of morbidities. Future prospective studies should be conducted with larger patient populations and longer follow-up periods.

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Fundoplication versus postoperative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy

Abstract: Fundoplication versus postoperative medication for gastro-oesophageal reflux in children with neurological impairment undergoing gastrostomy.

Cited by 32 publications

References 37 publications

Gastrostomy Placement and Management in Children: A Single-Center Experience

Gastrostomy Placement and Management in Children: A Single-Center Experience

Digestive tract neural control and gastrointestinal disorders in cerebral palsy

Unilateral Versus Bilateral Wrap Crural Fixation in Laparoscopic Nissen Fundoplication for Children

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