GASTROINTESTINAL REFLUX IN MENTALLY-DISAB LED CHILDREN - BENEFITS ANDEFFICACY OF SURGICAL-TREATMENT

A surgical antireflux procedure was done in 13 children with severe me ntal disabilities and in 95 neurologically-normal children between 197 2 and 1995. Immediate and delayed complications, postoperative mortali ty, long-term outcomes, and recurrences were studied. Of the 13 mental ly-disabled patients, two had severe immediate complications, namely m ediastinitis and intestinal obstruction due to intussusception; two ha d severe delayed complications, namely peritonitis and intestinal obst ruction due to adhesions; four had acute gas bloat syndrome; and two d ied, three and eleven months after the procedure respectively. A total of eight children in this group had a good outcome. Of the 95 neurolo gically-normal children, four developed delayed intestinal obstruction due to adhesions and requiring surgical treatment; three had recurren t gastroesophageal reflux successfully treated by a repeat operation; and none died. All mentally disabled children should be screened for g astroesophageal reflux to allow early diagnosis and treatment. Failure of conservative therapy is a common occurrence that should lead to su rgery. Although rates of postoperative morbidity, postoperative mortal ity, and recurrence are higher in mentally-disabled children, the surg ical procedure substantially improves patient comfort and facilitates care by family members and the staff of institutions for the mentally- disabled.