Bf. Gilchrist et al., A MODIFIED FEEDING ROUX-EN-Y JEJUNOSTOMY IN THE NEUROLOGICALLY DAMAGED CHILD, Journal of pediatric surgery, 32(4), 1997, pp. 588-589
Purpose: Feeding tube access with an antireflux procedure is frequentl
y necessary in children with severe neurological deficits. Fundoplicat
ion in this particular group of patients has many complications and a
reported failure rate of 40% to 50%, Recently, the use of a feeding Ro
ux-en-Y jejunostomy has been advocated in this population. Methods: Si
nce December 1993, over a g-month period, the authors performed 12 Rou
x-en-Y jejunostomies. All children had documented gastroesophageal ref
lux. One patient had a prior failed Nissen fundoplication, and none of
these patients were feeding significantly by mouth. Postoperative fol
low-up has been 12 months. Results: There were no deaths in this serie
s, One patient required early revision of the stoma because of marked
prolapse. One 11-month-old infant required reoperation 7 days postoper
atively because of tube dislodgment. Eight of the 12 patients required
out-patient procedures to unplug or replace the jejunostomy tube, Con
clusion: The operation may be beneficial in a subset of neurologically
impaired children who will never be able to ingest significant calori
es by mouth, It may also be useful after a failed fundoplication, The
main postoperative complications were plugging and dislodgment of the
jejunostomy tube, which if they occurred early, required x-ray confirm
ation for catheter placement. Copyright (C) 1997 by W.B. Saunders Comp
any.