THAL FUNDOPLICATION IN NEUROLOGICALLY IMPAIRED CHILDREN

Children with neurological impairment (NI) frequently require feeding gastrostomy, and this often aggravates or produces gastroesophageal re flux (GER). From 1976 to 1994, 141 children with severe NI underwent T hal fundoplication and gastrostomy (GT), GER was evident in 80%; in th e rest, fundoplication was an adjunct to GT. Ph results were positive in 38 cases, and 57 children had reflux according to the barium studie s. There were no major intraoperative complications. Disruption of the repair and/or recurrent GER was noted in 14 cases (10%); 8 were redon e as Thals, and 6 were converted to Nissen procedures. Pyloroplasty wa s done later in 9 children (6%), Dowel obstruction was seen in 4 patie nts (3%). Clinical follow-up (mean, 54 months) showed improvement in 9 6%; only 5 of the 141 (3.2%) have residual symptoms. Of the patients w ith an intact Thal, 67% could burp or vomit. The ability to vomit may protect the Thal fundoplication and avoid disruption of the repair. Co pyright (C) 1996 by W.B. Saunders Company