Anti-reflux gastrointestinal surgery in the neurologically handicapped child

Abstract

The frequent requirement for gastrointestinal feeding tubes in the mental-motor retarded (MMR) child has become a relative indication for concomitant anti-reflux surgery in many pediatric surgical centers. The need for the addition of this relatively morbid procedure to simple feeding tube placement remains controversial. To analyze the role of anti-reflux surgery in the MMR child, we reviewed our experience with enteral feeding access procedures and anti-reflux procedures. A total of 76 feeding access procedures (71 gastrostomies) and 98 anti-reflux procedures were performed. All patients were thoroughly evaluated for the presence of reflux preoperatively. The presence of asymptomatic reflux prior to feeding tube placement was not predictive of subsequent need for fundoplication. Only 3 of 71 patients with gastrostomies (4.2%) ultimately required fundoplication. Of 106 MMR children in this series, 48 had an anti-reflux operation with their feeding gastrostomy while 58 had a primary feeding tube alone, 2 of which were jejunostomies. Although 2 children in the gastrostomy group later required fundoplication for uncontrolled GER, the other 54 were managed without an anti-reflux procedure. Our experience does not support the routine performance of concomitant anti-reflux surgery with feeding tube placement in the MMR child and argues for a conservative approach to feeding access. Fundoplication should be reserved for those children with a clinical indication for an anti-reflux operation.