DELAYED GASTRIC-EMPTYING AFFECTS OUTCOME OF NISSEN FUNDOPLICATION IN NEUROLOGICALLY IMPAIRED CHILDREN

Background. Nissen fundoplication (NF) has a relatively high failure r ate in neurologically impaired children with gastroesophageal reflux ( GER). In 1990 we began to use routine technetium 99m sulfur colloid em ptying scans and pyloroplasty with NF for delayed gastric emptying (DG E) in our neurologically impaired patients. The aim of this study was to determine the influence of DGE and pyloroplasty on the outcome of N F in neurologically impaired children. Methods. One hundred neurologic ally impaired children underwent NF by a single surgeon between August 1986 and July 1995. Beginning in January 1990 emptying scans were rou tinely obtained and patients with DGE underwent pyloroplasty with NF. Outcome analysis was performed for recurrence/wrap failure and other p arameters. Mean follow-up was 5.8 years, with a minimum of 18 months. Results. DGE was found in 35 (65%) of the 54 children who had emptying scans. All II children with normal scans had successful NF without re current reflux (100%). Forty (93%) of 43 children who underwent pyloro plasty and NF had successful outcomes. Thirty-eight children underwent NF without evaluation of gastric emptying with success in 30 of them (78.9%). Overall success improved from 34 (83%) of 41 in the first hal f of the study, when 3 (7%) of 41 children underwent emptying scans, t o 55 (93%) of 59 in the second half; when 51 (86%) of 59 of the childr en underwent emptying scans. Conclusions. DGE is common in neurologica lly impaired children with GER. NF in children with normal gastric emp tying has a high probability of success. Pyloroplasty improves tile ou tcome of NF in children with DGE. Neurologically impaired children sho uld be evaluated for DGE before operation for GER.