Pediatric nutritional surgery and its implications: results from a unicentric retrospective analysis
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In brief
In brief
This retrospective study of 154 pediatric patients proposes a management pathway for nutritional surgery based on neurological status and presenting symptoms. Children with neurological impairment showed higher complication rates, with treatment ranging from isolated gastrostomy for dysphagia to total esophagogastric dissociation for complex cases.
- Children with neurological impairment undergoing nutritional surgery have higher complication and mortality rates than neurologically intact patients.
- Isolated gastrostomy is appropriate for neurologically impaired children with dysphagia alone, without gastroesophageal reflux.
- Nissen fundoplication is the primary intervention for children with GER, with or without dysphagia.
- Total esophagogastric dissociation (TEGD) showed excellent durability, with 92.3% of patients requiring no further procedures.
- Surgical approach should be tailored based on presenting symptoms (dysphagia, GER, delayed gastric emptying) and neurological status.
Written by the GCMD Library team from the article.
Abstract
Purpose
Existing guidelines provide weak recommendations on the surgical management of nutritional problems in children. The objective was to design a management pathway to address the best nutritional surgery (NS) procedure in a given patient.
Methods
Retrospective analysis of children treated at our department from January 2015 to December 2019. The sample was divided into two groups according to presence or absence of neurological impairment (NI). Patients with NI (Group 1) were classified in three subgroups based on presenting symptoms: A-Dysphagia without gastroesophageal reflux (GER); B-GER with or without dysphagia; C-Symptoms associated with a delayed gastric emptying.
Results
A total of 154 patients were included, 111 with NI. One-hundred-twenty-eight patients underwent only one procedure. Complications and mortality were superior in Group 1. In subgroup A, isolated gastrostomy was the first NS in all patients. In subgroup B most of patients were subjected to a Nissen fundoplication, while in 5 cases total esophagogastric dissociation (TEGD) was the first intervention. Considering the entire sample, 92.3% patients who underwent a TEGD did not require further procedures.
Conclusion
NS encompasses various procedures depending on presenting symptoms and neurological status. A management flowchart for these patients is proposed.