Routine anti-reflux surgery combined with gastrostomy in children: is it really necessary? Our single-center experience.

Autor:	Guillén Redondo P; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Espinosa Góngora R; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Luis Huertas AL; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Garcés Visier C; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Ramos Rodríguez P; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., De La Puente Pérez S; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Souto Romero H; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Espinoza Vega M; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Rico Espiñeira C; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Riñón Pastor C; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain)., Alonso Calderón JL; Pediatric Surgery Department. Niño Jesús Pediatric University Hospital. Madrid (Spain).
Jazyk:	English; Spanish; Castilian
Zdroj:	Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica [Cir Pediatr] 2021 Apr 01; Vol. 34 (2), pp. 67-73. Date of Electronic Publication: 2021 Apr 01.
Abstrakt:	Objective: To study gastroesophageal reflux (GER) in children undergoing gastrostomy in a single pediatric institution. Material and Methods: A retrospective study of patients undergoing gastrostomy from 2000 to 2017 was carried out. Demographic data, clinical data, progression, and complications were recorded. GER was considered positive in patients with clinical signs requiring antisecretory treatment, prokinetic treatment, or anti-reflux surgery to control symptoms. Results: 207 patients with a median age of 2 years [R: 0.25-18] were included. Neurological impairment was the most frequent underlying condition (74%). Swallowing difficulty and undernourishment were the main surgical indications for gastrostomy. Prior to gastrostomy, 96 out of 207 patients (46%) showed GER symptoms. Combined fundoplication and gastrostomy was performed in 41 (43%) patients with preexisting GER, 6 of whom showed GER worsening (4 required redo fundoplication). 5 complications following fundoplication were noted - gastric perforation, sustained Dumping syndrome, and gastroesophageal stenosis. 55 out of 96 (57%) patients with preexisting GER underwent gastrostomy alone. Clinical signs disappeared in 16 of them (29%) and improved or stabilized in 19 (35%). GER worsening occurred in 20 patients (36%), with subsequent fundoplication being required in 10 cases. In patients with no previous clinical signs (111 out of 207), GER symptoms occurred following gastrostomy in just 18 cases (16%), and only 2 patients required fundoplication. Conclusions: In our experience, routine anti-reflux surgery combined with gastrostomy is not justified. Individualized fundoplication should be considered in case of medical treatment failure. Further studies with an adequate design are required to establish which patients could really benefit from this procedure.
Databáze:	MEDLINE
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