Abstract
Purpose: Recently antireflux surgery has been frequently performed in neurologically impaired (NI) children with gastroesophageal reflux disease (GERD) and they often develop postoperative complications. In this study we describe our experience of 59 consecutive fundoplication in NI. Methods: From 1991 to 2007, we performed Nissen fundoplication in 59 NI children (33 boys and 26 girls. mean age 10.5 years old) with GERD. Results: An open procedure was performed in 26 cases (44.1%) and a laparoscopic procedure was performed in 33 cases (55.9%). Postoperative recurrence of reflux was revealed in 11 cases (18.6%), and 2 patients with severe symptoms of it required reoperation. Bowel obstruction occurred in 7 patients subjected to open and 2 to laparoscopic procedure (p=0.0351). We performed gastrostomy in 58 patients. Complication occurred in 35 cases and 3 patients with severe symptoms of them required revision. Laryngotracheal separation (LTS) was performed pre/post operation in 10 cases with severe respiratory aspiration. Postoperative death occurred in 8 cases but none in children with LTS. Conclusions: When fundoplication is performed in NI children, prevention against recurrence of reflux and gastrostomy with easy management are important and LTS is effective in cases with severe respiratory aspiration.
