BACKGROUND: To study clinical characteristics, mortality, morbidity and results of fundoplicature with or without gastrostomy in children, emphasizing neurologically impaired patients. METHODS: We studied retrospectively medical documents of 55 successive patients operated on in a period of five years (1994-1999), analysing variables related to clinical manifestations, epidemiology and post-operative evolution. Statistical analysis, when applicable, were perfomed using qui-square method. RESULTS: Respiratory symptoms, less than 6-month old infants and neurologically impaired children predominated. Opisthotonus was related to severe forms of gastroesophageal reflux disease (GERD). Thirty day mortality was 7,3%, significantly worse for those with congenital cardiac disease. Precocious complications were basically atelectasis and pneumonia (14,6%),with positive correlation to pre-operative severe malnutrition and surgical infections (5,5%). GERD recurred in 14,5%. After six post-operative months follow-up, cumulative taxes for pneumonias were 16,5%, versus 65% pre-operatively. In general there was nutritional improvement, despite large individual variations. CONCLUSION: It is essential to maintain a high index of suspition for GERD in small infants and neurologically impaired children with respiratory symptoms. In these groups surgery is more frequently necessary and essentially safe, except for nutritionally depleted children and in presence of severe cardiac defects.Opisthotonus suggests severe GERD. Surgical results are very favourable even for neurologically impaired children.
Gastroesophageal reflux; Brain damage, chronic; Fundoplication; Gastrostomy
