Nissen fundoplication may induce gastric myoelectrical disturbance in children

Background: Recurrent vomiting with failure to thrive is a common problem i n neurologically impaired children. Many undergo fundoplication to control the underlying gastroesophageal reflux, but the results of surgery are not always satisfactory, and postoperative retching may be a major problem. Ret ching is part of the emetic reflex and is associated with nausea, which is itself associated with disturbed gastric electrical control activity, resul ting in a gastric dysrhythmia. Methods: By recording gastric electrical control activity before and after Nissen fundoplication using the noninvasive technique of surface electrogas trography, the authors have shown that (1) Neurologically impaired children with gastroesophageal reflux more commonly have a preexisting gastric dysr hythmia (65% neurologically impaired v 20% neurologically normal children w ith gastroesophageal reflux, P<.05), (2) Children who retch preoperatively are three times more likely to retch postoperatively, and (3) 25% of neurol ogically impaired children may start to retch postoperatively for the first time. Conclusion: The authors propose that in neurologically impaired children, t oss of central inhibitory mechanisms may result in inappropriate activation of the emetic reflex, which may be heightened by antireflux surgery. J Ped iatr Sur 33:1801-1805. Copyright (C) 1948 by W.B. Saunders Company.