Early laparoscopic fundoplication and gastrostomy in infants with spinal muscular atrophy type I

J Pediatr Surg. 2008 Nov;43(11):2031-7. doi: 10.1016/j.jpedsurg.2008.05.035.

Abstract

Background/purpose: Spinal muscular atrophy (SMA) in children leads to progressive muscle weakness, dysphagia, aspiration, and death. We hypothesized that early laparoscopic fundoplication and gastrostomy in infants with SMA type I could be performed safely perhaps leading to fewer aspiration events and improved nutritional status.

Methods: Children diagnosed with SMA type I from 2002 through 2005 were included (n = 12). All children underwent laparoscopic Nissen fundoplication with gastrostomy shortly after diagnosis. Postoperative respiratory management and discharge criteria were standardized.

Results: All patients were extubated immediately postoperatively. There were no significant complications. Average time to full feeding and inpatient length of stay were 42 +/- 4.9 hours (range, 30-48 hours) and 78 +/- 22.5 hours (range, 44-120 hours), respectively. Mean weight-for-length percentile was doubled at 1 year postoperatively (P = .03). The number of respiratory-related hospitalizations in the cohort decreased by almost 50% in the ensuing 12 months after surgery, although this did not reach statistical significance in this small cohort (P = .34).

Conclusions: Early laparoscopic fundoplication and gastrostomy is safe and is associated with improved nutritional status. A trend toward fewer significant long-term aspiration-related events was seen after fundoplication. To better assess the long-term benefits of performing an antireflux procedure in these high-risk patients, a larger prospective trial comparing current nutritional support practices is needed.

Publication types

  • Evaluation Study

MeSH terms

  • Cohort Studies
  • Enteral Nutrition
  • Female
  • Fundoplication / methods*
  • Fundoplication / statistics & numerical data
  • Gastroesophageal Reflux / etiology
  • Gastroesophageal Reflux / surgery*
  • Gastrostomy*
  • Hospitalization / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Interdisciplinary Communication
  • Laparoscopy / methods*
  • Laparoscopy / statistics & numerical data
  • Length of Stay
  • Male
  • Malnutrition / prevention & control
  • Minimally Invasive Surgical Procedures
  • Patient Care Team
  • Postoperative Care
  • Postoperative Complications
  • Respiratory Aspiration / etiology
  • Respiratory Aspiration / prevention & control
  • Retrospective Studies
  • Spinal Muscular Atrophies of Childhood / complications
  • Spinal Muscular Atrophies of Childhood / surgery*