A MODIFIED FEEDING ROUX-EN-Y JEJUNOSTOMY IN THE NEUROLOGICALLY DAMAGED CHILD

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.