Ilhama Jafarli
We report our experience with 90 neurologically impaired children treated with gastrostomy and Nissen fundoplication. Malnutrition was the main problem, followed by aspiration, recurrent pneumonia, and vomiting. The symptomatology was caused by swallowing incoordination and gastroesophageal reflux. The diagnosis of gastroesophageal reflux was confirmed by upper gastrointestinal series and pH probe. Nissen fundoplication was performed following a standard technique with preservation of the vagus nerves and its branches, repair of the diaphragmatic crura, reconstruction of the angle of His, and a 360 degree wrap. A gastrostomy and pyloroplasty or pyloric dilatation were part of the operative procedure. There were no deaths and few complications related to the surgical procedure. Marked nutritional improvement was seen in most cases with an average weight gain of 3.2 kg/patient 3 months following surgery. There was also improvement in milestones and seizure control. The majority of parents were very satisfied and would recommend the procedure to other parents with similar problem Children with neurological impairment (NI) and swallowing incoordination seem to be in need for gastrostomy feeding. Because gastrostomy can cause or increase gastroesophageal reflux, an antireflux procedure has been advocated at the time of gastrostomy placement in neurologically impaired children, in terms of fundoplication. The purpose of this study is to evaluate clinical impression and risk-benefit ratio of fundoplication and gastrostomy tube placement in patients with cerebral palsy, birth asphyxia, brain tumors, HIE, Dandy-Walker syndrome and etc. It was observed wrap herniation, wrap slippage down to the stomach, and partial wrap disruption. As well as ALTE occurrence and frequent hospital admissions due to chest infections even after surgery were evaluated. Risks of gastrostomy, particularly in relation to surgical complications - leakage, granuloma, high residual, ileus have been described. A retrospective study data was entered and analyzed through statistical package SPSS version 22 conducted to identify inpatient hospitalizations for gastrostomy placements for the treatment of gastro esophageal reflux disease, feeding intolerance and swallowing disorder (2007–2016) at single institution.
