A prospective analysis of factors influencing outcome after fundoplication

doi:10.1016/0022-3468(95)90342-9

Journal of Pediatric Surgery

Volume 30, Issue 7, July 1995, Pages 1061-1064

https://doi.org/10.1016/0022-3468(95)90342-9 Get rights and content

Abstract

Fundoplication remains a common operation in the braindamaged pediatric patient, but recent reports suggest a poor outcome in these patients. The factors that might be associated with complications or recurrence after fundoplication have not been extensively examined. Fifty-six brain-damaged children, aged 6 months to 12 years, with documented gastroesophageal (GE) reflux underwent preoperative nutritional evaluations (percentage of ideal weight, albumin, nutrition risk index [NRI]) and documentation of medications (dexamethasone for bronchopulmonary dysplasia) before standard Nissen fundoplication. Hospital stay, intensive care unit (ICU) stay, and time on ventilator, as well as major postoperative complications (wound infection/dehiscence, pneumonia) were prospectively analyzed. Survival and recurrence rates 1 to 3 years postoperatively were also assessed. Eighty-two percent of patients were <90% ideal weight, and 50% had NRI < 90 (normal = 100) and 29% had albumin < 3.5 g/dL. Albumin < 3.5 was significantly (P < .01) associated with prolonged hospitaliaation (26.8 + 2.2 versus 15.1 + 1.1 days) and ICU stay (13.8 + 1.0 versus 4.4 + .5 days) and time on ventilator (8.0 + 1.0 versus 1.8 + .4 days). NRI < 90 showed similar significant differences (P < .01). Ideal body weight < 90% was not significant. Major complications developed in 54% of patients; only two or more preoperative nutritional deficiencies, or a nutritional deficiency plus dexamethasone were significantly associated (P < .01). Recurrence occurred in 21% of patients and was significantly and especially when dexamethasone plus a nutritional deficit were present (low albumin, P < .001; low NRI, P < .005). No factor correlated with survival. These data show that preoperative nutritional status greatly affects short- and long-term results after fundoplication, especially when steroids are also administrred, suggesting that preoperative nutritional support might benefit these patients.

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2020, Physical Medicine and Rehabilitation Clinics of North America
Citation Excerpt :
Although the consequences of malnutrition in children without disabilities have been well studied,19 research in children with motor disabilities is less well described, with many experts believing that the effects on unaffected individuals are applicable to undernourished children with CP.10 Furthermore, the evidence regarding some of the benefits of adequate nutrition, such as its relationship to surgical morbidity, specifically in children with CP is conflicting.20–22 However, poor growth and nutrition could be a contributing factor to (rather than solely a reflection of) a child’s medical complexity and its subsequent encumbrance on the life of both child and caregivers.
Gastroesophageal Reflux Disease
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Gastroesophageal Reflux Disease
2012, Pediatric Surgery
Relationship of nutritional status to health and societal participation in children with cerebral palsy
2002, Journal of Pediatrics
Objectives: To describe nutritional status in a population-based sample of children with moderate or severe cerebral palsy (CP) and to explore the relationships between nutritional status and health and functional outcomes. Study design: A population-based strategy was used to enroll children with CP at 6 geographic sites. Research assistants performed anthropometric assessment, determined severity of motor impairment, and interviewed caregivers with the Child Health Questionnaire and a questionnaire designed specifically for this study. Anthropometric measures were converted to Z scores and the relationship between health and nutritional status was assessed using regression models. Results: Among the 235 participants, indicators of malnutrition were common. Poor nutritional status correlated with increased health care utilization (hospitalizations, doctor visits) and decreased participation in usual activities by the child and parent. Conclusions: Malnutrition is common in children with moderate or severe CP and associated with poorer health status and limitations in societal participation. Further studies are needed to determine the nature of these associations and how to manage nutrition in children with CP to optimize growth and health outcomes. (J Pediatr 2002;141:637-43)
Laparoscopic surgery for gastroesophageal reflux disease during the first year of life
2001, Journal of Pediatric Surgery
Citation Excerpt :
In cases of dismotility or in babies operated on at birth for esophageal atresia, a partial fundoplication according to Toupet may be preferable.1 Follow-up is mandatory for at least 2 years, because several complications can occur not only 12 months after surgery but also in late follow-up.11,12 Performing LF on a patient during the first year of life requires advanced laparoscopic surgical skills and prior experience of LF in older children.
Background: Very few children need gastroesophageal antireflux surgery during their first year of life; hence, no series has been published so far. The authors report their experience in 3 centers. Methods: From January 1993 to December 1998, 36 infants between 23 days and 13 months of age, suffering from gastroesophageal reflux disease (GERD), underwent surgery by a laparoscopic approach. The patients' weights ranged from 2.4 to 8.5 kg. Preoperative diagnostic studies included esophagograms, manometries, endoscopies, and pH-metries. Fifteen babies (41.6%) had associated anomalies, and 10 (27.7%) were neurologically impaired. Thirty-six laparoscopic fundoplications were performed according to either Toupet's procedure (17 of 36), Rossetti's (10 of 36), Nissen's (8 of 36) or Lortat-Jacob's (1 of 36). Four infants previously had undergone a gastrostomy, whereas 6 needed one during the antireflux procedure. Results: There was no mortality in our series. Three infants (8.3%) had an intraoperative complication: 1 lesion of a diaphragmatic vessel, 1 pneumothorax, and 1 case of severe hiatal hernia requiring conversion to open surgery. During the median follow-up of 22 months, 4 redo procedures were performed (11.1%). Conclusions: This experience shows the feasibility of laparoscopic fundoplication even in children below 1 year of age. An accurate preoperative diagnostic study is mandatory, because 50% of these patients presented associated anomalies. A long and accurate follow-up is necessary to evaluate long-term results and detect possible complications, which can occur as late as 1 year after surgery. In addition, we believe that redo antireflux surgery is possible by the laparoscopic approach without major difficulties, based on our larger experience with older children. J Pediatr Surg 36:715-717. Copyright © 2001 by W.B. Saunders Company.
Outcome of Nissen fundoplication using intraoperative manometry in children
1998, Journal of Pediatric Surgery
Background: Intraoperative manometry is useful in performing Nissen fundoplication (NF) in children. Long-term clinical outcome information after use of this method is lacking.
Methods: A retrospective review of the outcomes of 62 consecutive NFs using intraoperative manometry was performed. The follow-up period was 3.4 years. Approximately half of the patients were neurologically normal (NN) and half were neurologically impaired (NI). All patients with gastroesophageal reflux disease (GERD) did not respond to an adequate trial of medical treatment.
Results: The NF was tailored to result in a twofold increase in the lower esophageal sphincter pressure (LESP) and a 75% increase in the LES length (LESL). An accelerated growth rate in 40% of “failure to thrive” (FTT) patients was demonstrated. Eighty-four percent of caregivers reported improved quality of life after NF. There was a twofold reduction in the number of hospital admissions and a sixfold reduction in total inpatient days for both NI and NN children. The early and late mortality rate was 13%, and the complication rate was similar to other series reported in the literature, with more complications occurring in NI patients. There was a 2% incidence of wrap herniation. An improvement in long-term outcomes after NF was seen in 89% of NN children and over half of NI patients.
Conclusions: Intraoperative manometry is useful in standardizing the tightness of the wrap in NF. There was a low incidence of complications, dysphagia, recurrent emesis, and GERD in this series. Long-term outcomes using this technique were deemed very good based on caregivers' responses.

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^☆: Presented at the 1994 Annual Meeting of the Section on Surgery of the American Academy of Pediatrics, Dallas, Texas, October 21–23, 1994.

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A prospective analysis of factors influencing outcome after fundoplication☆

Abstract

Am J Clin Nutr

Nissen fundoplication in children with profound neurologic disability. High risks and unmet goals

Ann Surg

Gastroesophageal reflux in childhood: The dilemma of surgical success

Ann Surg

Perioperative total parenteral nutrition in surgical patients

N Engl J Med

Growth response to enteral feeding by children with cerebral palsy

JPEN