The Efficacy and Long-Term Outcome of Laparoscopic Nissen Fundoplication in Neurologically Impaired Children

Abstract

Objective:

This study presents the clinical outcome of laparoscopic Nissen fundoplication in neurologically impaired children with severe and resistant gastroesophageal reflux (GER).

Patients and Methods:

Forty-two neurologically impaired children who had failed medical treatment for severe GER underwent laparoscopic Nissen fundoplication. Indications for surgery included feeding difficulty in all, emesis in 16, respiratory symptoms in 9, and mixed emesis and respiratory symptoms in 13. Thirty-six patients (86%) were profoundly impaired with cerebral palsy and 19 (45%) had severe scoliosis. The laparoscopic procedure was performed using a five-trocar technique with 5-mm instruments.

Results:

Two children required conversion to open procedure. The remaining 40 children underwent laparoscopic procedures without intraoperative complications. There was no operative mortality. Although early morbidity was high (30%), most of the complications were relieved within a few months. All patients with emesis had improved clinically and were free of vomiting, whereas only 5 of 9 patients (56%) with respiratory symptoms improved postoperatively. Three children (7%) with recurrent reflux underwent open redo fundoplication. To date, 8 children (19%) have died. Five died of respiratory disease and 3 died of their background condition.

Conclusions:

Our results suggest that the outcomes of laparoscopic Nissen fundoplication in neurologically impaired children compare favorably with those of the open procedure. Because of the high incidence of late death in patients with persistent respiratory symptoms, prophylactic airway management should be considered to reduce long-term mortality.