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Concomitant gastrostomy tube insertion during laparoscopic Nissen fundoplication for gastro-esophageal reflux disease: analysis of risk factors for fundoplication failure

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Abstract

Background

Laparoscopic Nissen fundoplication (LNF) and gastrostomy tube (GT) placement may be performed concomitantly in children with gastro-esophageal reflux disease (GERD) and failure to thrive. We aimed to evaluate the rate and risk factors for LNF failure in children undergoing concomitant LNF/GT.

Methods

A retrospective multi-institutional cohort study was conducted, reviewing patients that underwent LNF (2005–2014). Data collected included patient demographics, comorbidities, and type of GT (laparoscopy- or endoscopy-assisted). The primary outcome measure was LNF failure. Data was compared using contingency tables or Mann–Whitney tests, when appropriate. An exploratory analysis by Kaplan–Meier survival and Cox proportional hazards analysis was performed to determine predictors of time to LNF failure after LNF/GT.

Results

Of 189 children that underwent LNF, 99 (52%) had a concomitant GT (55% laparoscopy-, 45% endoscopy-assisted). LNF failed in 15% after LNF/GT and in 17% after LNF alone (p = 0.84), at a median age of 23 months (IQR 8–41). Using univariate analysis, we found that a younger age at the time of surgery (p = 0.05), prematurity (p = 0.0018), esophageal atresia (p = 0.01), and endoscopy-assisted GT (p = 0.02) were potential predictors of LNF failure after LNF/GT. After multivariate regression analysis, prematurity (p = 0.007) remained significantly associated with LNF failure after LNF/GT. No predictive factors for LNF failure after LNF alone were identified.

Conclusions

Concomitant GT insertion and LNF is a common practice, as half of the children that undergo LNF also received GT insertion. Children born preterm or with esophageal atresia comprise a fragile population at high-risk of LNF failure after LNF/GT. Prospective, multicentric studies are needed to evaluate the best GT technique to use in children undergoing LNF.

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Authors and Affiliations

  1. Department of Pediatric General Surgery and Urology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019, Paris, France

    Louise Montalva, Aurora Mariani, Cécile O. Muller, Matthieu Peycelon & Arnaud Bonnard

  2. Department of Pediatric Surgery, Centre Hospitalier Universitaire Angers, Angers, France

    Françoise Schmitt & Khalid Alzahrani

  3. Department of Gastroenterology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

    Jérôme Viala & Alexis Mosca

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  1. Louise Montalva
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Correspondence to Arnaud Bonnard.

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Drs. Louise Montalva, Aurora Mariani, Françoise Schmitt, Cécile O. Muller, Jérôme Viala, Alexis Mosca, Matthieu Peycelon, and Arnaud Bonnard have no conflicts of interest or financial ties to disclose.

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Montalva, L., Mariani, A., Schmitt, F. et al. Concomitant gastrostomy tube insertion during laparoscopic Nissen fundoplication for gastro-esophageal reflux disease: analysis of risk factors for fundoplication failure. Surg Endosc 35, 4251–4258 (2021). https://doi.org/10.1007/s00464-020-07913-w

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