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

AbstractBACKGROUND/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.
AuthorsEmily T Durkin, Mary K Schroth, Margaret Helin, Aimen F Shaaban
JournalJournal of pediatric surgery (J Pediatr Surg) Vol. 43 Issue 11 Pg. 2031-7 (Nov 2008) ISSN: 1531-5037 [Electronic] United States
PMID18970936 (Publication Type: Evaluation Studies, Journal Article)
Topics
  • Cohort Studies
  • Enteral Nutrition
  • Female
  • Fundoplication (methods, statistics & numerical data)
  • Gastroesophageal Reflux (etiology, surgery)
  • Gastrostomy
  • Hospitalization (statistics & numerical data)
  • Humans
  • Infant
  • Infant, Newborn
  • Interdisciplinary Communication
  • Laparoscopy (methods, statistics & numerical data)
  • Length of Stay
  • Male
  • Malnutrition (prevention & control)
  • Minimally Invasive Surgical Procedures
  • Patient Care Team
  • Postoperative Care
  • Postoperative Complications
  • Respiratory Aspiration (etiology, prevention & control)
  • Retrospective Studies
  • Spinal Muscular Atrophies of Childhood (complications, surgery)

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