J. Yoon1, J. Gross1, S. Burjonrappa1 1St.Jospeh’s Regional Medical Center,Surgery/Pediatric Surgery,Patterson, NJ, USA
Introduction: Anti-reflux surgery is offered only to those who fail medical management for gastro-esophageal reflux (GERD) in the pediatric population. The general consensus is that most infants would grow out of their reflux with medical management only. A handful of studies show that those with neurologic impairment have benefited from these procedures; however, there are few studies that document the outcomes for infants less than 6 months of age. This study investigates the short-term outcomes of Nissen Fundoplication (NF) in this population.
Methods: We performed a retrospective analysis of children less than 6 months of age who underwent Nissen Fundoplication at our institution from December 2006 – June 2013. The following factors were analyzed: surgical indications, co-morbidities, hospital course data, weight gain, length of stay, and complications.
Results: 23 patients were studied in this analysis (average age: 95.8 days, median 90 days). Pre-surgery, these patients on average were in the 9.88 percentile for weight (median 0.9 percentile) and 21/23 (91.3%) patients were under the 50th percentile. 19/23 (82%) patients underwent NF for GERD and 16/23 (69%) patients had poor feeding prior to the surgery. All patients had concomitant gastrostomy tube creation. All patients had co-morbidities other than GERD/ poor feeding. 18/23 (78%) had anatomic or genetic abnormalities. 11/24 (45.8%) patients underwent an upper gastrointestinal contrast study that was positive for reflux. Diet was advanced on average post-operative day 2.39 and the patients were tolerating their goal diet by post-operative day 6.45 (median 5.5). All but 3 patients were discharged on diets more substantial (by volume) than their highest pre-operative diet. On average, these patients were on 1.9 GERD related medications before surgery (Pepcid most common), but decreased to 0.7 GERD related medications after surgery. Of the 15 patients who were still on GERD medications after surgery, only 2 were discharged with medications. Patients who were observed for longer than 2 weeks in an inpatient setting (10/23 patients) had an improvement in weight percentile (average 9.79 to 14.97 percentile; median 1.4 to 3.2). 7/24 (29.2%) patients had complications related to their g-tube, the main complaint being leakage around the tube.
Conclusion:Infants undergoing NF under the age of 6 months are very sick patients with multiple co-morbidities. They have exhausted all options for weight gain due to excessive reflux and/or poor feeding. Our study shows that NF in these patients improves their ability to gain weight and also decreases the overall need for GERD related medications.