To wrap or not to wrap: Does concomitant fundoplication at the time of gastrostomy tube placement remain a question?

PURPOSE: Gastrostomy tube (GT) placement is common in infants with oral aversion and/or oropharyngeal dysphagia. Historically, GT placement was combined with fundoplication to mitigate gastroesophageal reflux disease (GERD) and aspiration. This study aimed to evaluate the impact of concomitant fundoplication on pulmonary complications and the need for post-pyloric feeds following GT placement.

METHODS

A single institution review of infants <6 months-old undergoing GT placement for oral aversion and/or oropharyngeal dysphagia was performed (January 2011-June 2025). Patients with medically-refractory GERD were excluded. Pulmonary complications were defined as postoperative admissions for aspiration or bacterial pneumonia. Univariate and multivariate analyses were performed.

RESULTS

Among 649 infants undergoing GT placement, 56% had a concomitant fundoplication. Comorbidities were similar between groups. Fundoplication was associated with increased pulmonary complications compared to GT alone (18% vs. 11%, p = 0.01), particularly among infants with neurologic (26% vs. 12%, p < 0.01) or craniofacial disorders (26% vs. 14%, p = 0.04). On multivariate analysis, concomitant fundoplication (OR 1.76, 95%CI 1.11-2.79), craniofacial disorders (OR 1.74, 95%CI 1.09-2.75) and neurologic disorders (OR 1.88, 95%CI 1.21-2.93) were independently associated with postoperative pulmonary complications. Three infants (1%) underwent metachronous postoperative fundoplication. Rates of postoperative conversion to a gastrojejunostomy for refractory GERD were similar between groups (7% GT alone vs. 5% concomitant fundoplication, p = 0.29).

CONCLUSION

Concomitant fundoplication is independently associated with increased risk of pulmonary complications in infants undergoing GT placement and does not reduce the need for postoperative conversion to post-pyloric feeds. Further, the need for future fundoplication in those undergoing GT alone is rare.

TYPE OF STUDY: Retrospective cohort study.

LEVEL OF EVIDENCE: III.