Fundoplication, the final word for reflux… or is it?

Infants with severe neurological impairment may have difficulty with oral feeding, and are at risk of aspiration if they regurgitate. Therefore when a feeding gastrostomy is performed, there is often an accompanying fundoplication, It even becomes sometimes so banal that the term ‘gastro-fundo’ may be used (I say banal not to imply that the implications are minimized by the medical and nursing staff, but it has become almost routine for a subgroup of infants).

But is it a good idea? In such infants, if they need a gastrostomy should we routinely perform a fundoplication? Does fundoplication improve outcomes, reduce regurgitation, prevent re-admission, prevent aspiration, improve quality of life?

I used to think that fundoplication was a clearly proven therapy for preventing regurgitation, and therefore it must be a good thing for infants at risk of aspiration. This new study evaluated the records of over 4000 infants with impairments and a gastrostomy who either did or did not have a fundoplication at the same time. It ends with the following paragraph summarizing their results:

Infants with neurological impairment who underwent fundoplication at the time of GT placement did not have a reduced rate of reflux-related hospitalizations during the first year compared with those who underwent GT placement alone, despite propensity score matching. This may be due to a lack of effectiveness of fundoplication in preventing these complications or due to differences in the patient groups that were inadequately accounted for in the matching.

I think the final sentence is absolutely correct, these data show no benefit of fundoplication, but why? We need to know, so that these vulnerable children can get the best interventions targeted to improving their outcomes, and their, and their families’, quality of life. .

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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