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

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 less than 0.001), gastroesophageal reflux (GER) - related admissions (0.67 versus 0.09; p less than 0.001), and admissions for seizures (0.21 versus 0.01; p less than0.001 were significantly decreased. Furthermore, all emergency department visits (0.94 versus 0.23; p less than 0.001), GER visits (0.61 versus 0.12; p less than 0.001), seizure visits (0.24 versus 0.01: p less than 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 less than 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 and GT in DNR children, anti-reflux medications with GT might be an alternative.