Surgical approach and antireflux surgery results in gastroesophageal reflux disease in children with neurological deficit

Objectives: The study aimed to evaluate the surgical results of antireflux surgery (ARS) in neurologically impaired children with gastroesophageal reflux disease (GERD) who underwent surgery in our clinic. Patients and methods: This retrospective study included 84 children (50 males and 34 females; mean age: 44.4±49 months; range, 2 to 224 months) between January 2011 and October 2016. Data on patient demographics, indications for surgery, preoperative symptoms, preoperative diagnostic tests, surgical procedures, complications, and reoperations were collected. Results: The mean follow-up period was 17.9±22.5 months. The most frequent underlying pathology was cerebral palsy (67.4%). The main indication was recurrent aspiration pneumonia (77.1%). Preoperative diagnostic tests included an upper gastrointestinal contrast study (78.6%), gastric emptying study (69%), 24-h pH monitoring (21.4%), and endoscopy (8.3%). Surgical procedures included laparoscopic Nissen fundoplication (LNF) and gastrostomy in 61 patients, only LNF in 12 patients, and open Nissen fundoplication and gastrostomy in five patients. Laparoscopic Nissen fundoplication and pyloroplasty were performed in three patients, and LNF, gastrostomy, and pyloroplasty were performed in three patients. In the postoperative period, 58.3% of patients were free of symptoms. Postoperative complications occurred in six patients. A redo Nissen fundoplication was performed in four patients. Three of these patients were diagnosed with a postoperative hiatal hernia. However, the wrap was intact in all three of them. One patient had a laryngotracheoesophageal cleft anomaly and underwent redo surgery. One patient died in the early postoperative period owing to nonsurgical reasons. Seventeen patients died due to nonsurgical reasons. Conclusion: The indications and postoperative results of ARS in children with cerebral palsy are controversial. According to our results, the main indication for ARS was recurrent aspiration pneumonia, which decreased dramatically in the postoperative period. Long-term results suggest that 58.3% of our patients did not have any complaints and benefited from surgical treatment. Antireflux surgery is an effective and safe treatment for GERD in children with neurological deficits.