Weight gain and resource utilization in infants after fundoplication versus gastrojejunostomy

Infographic · May 2022 · 1 min read

In brief

This retrospective study of 125 infants compared laparoscopic fundoplication versus gastrojejunostomy tube placement, finding that fundoplication resulted in significantly better weight gain (0.85-unit higher Z-score) and fewer unplanned healthcare encounters at one year. The GJ cohort required an average of 3.3 planned tube exchanges within the first year, contributing to higher overall healthcare utilization.

Laparoscopic fundoplication resulted in 0.85-unit greater weight-for-age Z-score increase compared to gastrojejunostomy at 1 year
GJ tube patients had significantly more unplanned healthcare encounters (4.2 vs 3.0) and required average 3.3 planned tube exchanges yearly
For infants intolerant of gastric feeds, fundoplication may offer superior weight gain with reduced healthcare utilization versus GJ tubes
Practice variation exists in choosing fundoplication versus GJ tubes; standardized guidelines are needed for this common clinical scenario

Written by the GCMD Library team from the infographic.

The infographic uses a split layout with surgical diagrams on the right showing two procedures side by side. The left side contains patient population icons and a warning symbol. Central data visualizations include a scale icon showing weight measurements and a hospital building icon with downward arrow. Color scheme uses red headers, blue accent numbers, and grayscale illustrations.

Purpose

There is wide practice variation in the use of laparoscopic fundoplication (LF) versus gastrojejunostomy (GJ) tube insertion for children who do not tolerate gastric feeds. Using weight gain as an objective proxy of adequate nutrition, we sought to evaluate the difference in weight gain between LF and GJ.

Methods

A retrospective, cohort study was conducted of patients ≤ 2 years who underwent LF or GJ between 2014 and 2019 at a single institution. Patient characteristics, change in weight 1-year post-procedure and frequency of unplanned healthcare utilization encounters were collected and examined.

Results

A total of 125 patients (50.4%LF, 49.6%GJ) were identified. Adjusted modeling demonstrated that on average, there was an additional 0.85-unit increase in weight-for-age Z scores in the LF compared to the GJ cohort (p = 0.01). The GJ cohort had significantly more unplanned healthcare utilization encounters (4.2, SD 3.4) compared to LF (3.0, SD 3.1) (p = 0.03). Furthermore, the GJ cohort underwent an average of 3.3 planned GJ exchanges within 1-year post-procedure.

Conclusion

In the first year post-operatively, LF is associated with increased weight gain and fewer unplanned and overall healthcare encounters compared to GJ. Long-term outcomes including weight gain and quality-of-life measures should be studied to develop standardized guidelines for this common clinical scenario.

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