RISKS AND BENEFITS OF ANTIREFLUX OPERATIONS IN NEUROLOGICALLY IMPAIRED CHILDREN

Gastro-oesophageal reflux (GER) in neurologically impaired children of ten causes feeding problems and complications of oesophagitis and is f requently resistant to medical treatment. Fifty neurologically impaire d children underwent anterior gastropexy as anti-reflux operation, com bined with gastrostomy in 23, between 1976 and 1992. The was no operat ive mortality. There were 25 early complications in 14 patients and 9 late complications in 9 patients. Twelve patients needed 17 re-operati ons for delayed gastric emptying [4], intestinal obstruction [3], para -oesophageal hernia [3], oesophageal stenosis [4], and recurrent GER, revision of gastrostomy, subphrenic abcess (one each). Nine patients d ied during the follow up period. Death in two children was related to the operation (incarcerated para-oesophageal hernia and blowout of the stomach). Out of 41 survivors, the operation was judged successful in 35. It is concluded that antireflux operations in neurologically impa ired children carry a high risk of complications. Preoperative identif ication of risk factors is not possible. The improvements in the quali ty of life achieved in the majority of patients outweigh the risks.