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Antireflux Surgery in Children With Neurological Impairment: Caregiver Perceptions and Complications

O’Loughlin, Edward V.*; Somerville, Helen*; Shun, Albert; Gangemi, Rachel*; La Hei, Erik; Desphande, Aniruddh; O’Loughlin, Timothy F.

Journal of Pediatric Gastroenterology & Nutrition: January 2013 - Volume 56 - Issue 1 - p 46–50
doi: 10.1097/MPG.0b013e318267c320
Original Articles: Gastroenterology

Objectives: The aim of the present study was to report caregiver perceptions to antireflux surgery and gastrostomy in children with severe neurological impairment and to report the complications of the surgery.

Methods: Children were identified from a clinic database and clinical information and surgical complications were extracted from the database and hospital medical records. A cross-sectional questionnaire addressing severity of symptoms was administered to parents/caregivers and scored with a 5-point Likert scale (1 is much better to 5, much worse).

Results: A total of 122 children, median age 74 months (interquartile range 29–124), 63% spastic quadriplegic cerebral palsy, had antireflux surgery. Laparoscopic surgery was performed in 77 of 122 (63%) and 117 of 122 (96%) had gastrostomy insertion. Questionnaire was completed by 89 of 122 (73%) children; median duration of time from fundoplication to questionnaire was 77 months (43–89). The majority of caregivers indicated that surgery improved or greatly improved weight gain, chest infections, vomiting, and feeding tolerance. Only 2 caregivers reported that they regretted consenting to surgery. Serious surgical complications occurred in 10%.

Conclusions: Serious complications were uncommon in this series of antireflux surgery in neurologically impaired children. Although gagging and retching were common following surgery, a high percentage of caregivers reported improved nutrition, reflux-related symptoms, and high levels of satisfaction.

*Department of Gastroenterology

Department of Surgery, Children's Hospital at Westmead

Faculty of Medicine Sydney University, Sydney, Australia.

Address correspondence and reprint requests to Dr Edward O’Loughlin, Department of Gastroenterology, Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia (e-mail: Tedo@chw.edu.au).

Received 18 September, 2011

Accepted 21 June, 2012

The present study was partially funded by Aging Disability and Home Care (ADHC), NSW government. Clinics were in part funded by Aging Disability and Home Care (NSW government).

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN