P0748 SURGICAL INTERVENTION FOR DELAYED GASTRIC EMPTYING IN THE NON-HANDICAPPED CHILD

Abstract

Introduction: Although chronic vomiting is a common presenting symptom in both the neurologically handicapped and non-handicapped child, a history pointing clearly to delayed gastric emptying is relatively rare. Investigations may suggest delayed gastric emptying with or without gastro-oesophageal reflux. Whether surgery should attempt to enhance gastric emptying without also correcting gastro-oesophageal reflux is debated. We present our experience of surgical intervention in this group of patients. Methods: This is a retrospective case note review of children without neurological handicap referred to a tertiary centre, who underwent a surgical procedure as treatment for delayed gastric emptying without any antireflux procedure. Results: Between January 1999 and December 2004 seven patients underwent a Heineke-Mikulicz pyloroplasty. They were aged between seven months and fourteen years and all presented with a history suggestive of delayed gastric emptying, confirmed by radio-isotope scan. All children failed to respond to prokinetic agents before undergoing surgery. Pyloroplasty was performed as an open procedure in the first three patients and laparoscopically in the other four. In six patients with follow-up of greater than eight months (range eight months to three years), all have improved although one child still vomits if a large meal is taken. The seventh child has only recently undergone the procedure but their results will be presented. Although the childen who underwent laparoscopic surgery did not achieve earlier discharge, pain relief and cosmetic results were improved. There were no surgical complications. Conclusion: We believe that pyloroplasty alone is a good operation for children with vomiting due to delayed gastric emptying. We would argue that the recognised complications following anti-reflux surgery (1) are such that, in a non-neurologically handicapped child, gastric emptying should be assessed and treated in isolation, if found to be abnormal.