Nissen fundoplication in severely ill infants: A STROBE compliant study

Abstract

Aim: Anti-reflux surgery is offered to those who fail medical management for gastroesophageal reflux disease (GERD) in the pediatric population. A handful of studies show that those with neurologic impairment have benefited from these procedures; however, there are a few studies that document the indications and outcomes for infants < 6 months of age. Methods: A retrospective analysis of children < 6 months of age who underwent a Nissen fundoplication (NF) at St. Joseph's Regional Medical Center from December 2006 to June 2013 was performed. The following factors, such as surgical indications, comorbidities, hospital course data, weight gain, length of stay, and complications, were analyzed. Results: A total of 23 patients with the average age of 95.8 days were studied in this analysis. Presurgery, the average weight of these patients was 9.88 percentile (interquartile range: 5.85). A total of 65.2% patients were considered having failure to thrive (FTT) as they were under the 10th percentile and 78% patients had anatomic or genetic abnormalities. Nearly 47.8% patients underwent upper gastrointestinal studies that were positive for reflux. All patients had a concomitant gastrostomy tube (G-tube) placed during the NF. Diet was advanced on the average postoperative day of 2, and the patients tolerated the highest diet by the postoperative day of 6. Most patients saw a decrease in medications after the procedure. Moreover, 7 patients had complications related to the G-tube, with the main complication reported as leakage around the tube. There were two mortalities, both unrelated to the operation. Conclusion: Infants undergoing NF under the age of 6 months typically present with multiple comorbidities. NF in this population will not only lead to weight gain but also decrease in overall need for GERD-related medications. Early recognition of the failure of nasojejunal feeds will facilitate NF before significant FTT is present.