Outcomes of paediatric fundoplication stratified by subtype of neurological impairment

Abstract

Aims: Jejunal feeding is increasingly seen as an alternative to fundoplication in neurologically impaired children. However, fundoplication may offer important advantages. This study aimed to determine: (i) contemporary outcomes of fundoplication from a sub-specialised service; and (ii) whether outcomes were influenced by neurological characteristics. Methods: Single-centre retrospective review of consecutive children undergoing fundoplication by three surgeons over five years (2017–2022) using a standardised technique. Children were stratified as neurologically unimpaired, static brain injury, neuromuscular condition or neurodegenerative impairment. Failure was defined as a requirement for subsequent jejunal feeding or further surgery. Data are presented as median (IQR) unless stated. Comparisons used Fisher's test. Results: 144 children underwent fundoplication at 1.9 years (1–5 years): 97/144 (67 %) had neurological impairment. Surgery was completed laparoscopically 128/144 (89 %) and converted in 9/137 (7 %). 84/144 (60 %) underwent concomitant gastrostomy formation. At 35 months (22–47), absolute failure was 16 % (23/144). Failure was higher in those with neurodegenerative conditions (not significant). Persistence of symptoms was noted in 23/144 (16 %). Two (1.4 %) required reoperation (<30 days). Nine (6.4 %) required admission to critical care. One death within 30 days was unrelated. Conclusions: Given fundoplication may provide significant benefits (avoiding pump feeds, frequent tube failure/changes and risk of jejunal perforation), success rates are high and morbidity low, fundoplication should be offered to families as an alternative to jejunal feeding as part of comprehensive counselling. There was no significant difference in outcome between neurological impairment subtypes in this sample size.

Keywords

• Fundoplication
• Neurological impairment
• Gastro-oesophageal reflux
• Gastrojejunal feeding