The outcomes of fundoplication and gastrostomy in neurologically impaired children in a tertiary care hospital in Saudi Arabia

Abstract

Objectives: To evaluate the outcomes of fundoplication and gastrostomy (GT) in neurologically impaired (NI) children. Methods: A retrospective review of medical charts was performed on 178 NI children up to the age of 14 years inclusive, who underwent fundoplication and GT between 1999 and 2014. Results: After fundoplication, the incidence-rate (person-month) of all hospital admissions (0.95 versus 0.13; p<0.001), gastroesophageal reflux (GER) - related admissions (0.67 versus 0.09; p<0.001), and admissions for seizures (0.21 versus 0.01; p<0.001 were significantly decreased. Furthermore, all emergency department visits (0.94 versus 0.23; p<0.001), GER visits (0.61 versus 0.12; p<0.001), seizure visits (0.24 versus 0.01: p<0.001) were significantly reduced. The mortality rate after fundoplication was 35%.The risk factors for predicting mortality were being male (odds ratio: 2.2, p=0.027) and being a do not resuscitate (DNR) child (odds ratio: 5.2, p<0.001). Majority of the children that died within a year after the procedure were DNR. Conclusions: Fundoplication with GT is effective in reducing hospital admissions and emergency department visits from GER and seizures in NI children. Because of high mortality within a year of fundoplication with GT in DNR children, anti-reflux medications with GT might be an alternative.