Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

Abstract

Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1–12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.

Innovative Techniques Associated with Traditional Abdominal Surgery in Complex Pediatric Cases: A Tertiary Center Experience

“…were observed in 30% of the patients, while short-term major complications (respiratory infections, malfunctioning or displacement of the device, etc.) were detected in 9% of the patients [6].…”

“…Besides isolated diagnostic or therapeutic endoscopy, the association of this technique with laparoscopic surgery is gaining popularity in abdominal surgeries. In this regard, simultaneous Nissen laparoscopic fundoplication and percutaneous endoscopic gastrostomy (PEG) [5] is one of the main associations performed at our center, mainly in neurologically impaired children [6]. Nissen fundoplication is the most common surgical approach for gastro-esophageal reflux, consisting of a posterior 360 degrees fundoplication, and aiming to re-establish proper esophagogastric junction [7,8].…”

New Surgical Frontiers for Nutrition in Children

“…Another important topic in children is nutrition in neurologically impaired patients. Considering the need, or not, of a fundoplication to protect the respiratory tract, Elisa Zambaiti and her colleagues report the experience of a single center, in which there was no difference between gastrostomy with and without fundoplication [ 6 ].…”