J. L. Carpenter1, T. A. Soeken1, A. J. Correa1, I. J. Zamora1, S. C. Fallon1, M. J. Kissler1, C. D. Fraser2, D. E. Wesson1 1Texas Children’s Hospital,Division Of Pediatric Surgery, Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Division Of Congenital Heart Surgery, Department Of Surgery,Houston, TX, USA
Introduction: Malnutrition is common among children with complex heart disease (CHD) presumably due to a combination of sub-optimal intake and increased energy expenditure. Feeding gastrostomies are often used to improve the nutritional status of such patients. Many also have evidence of gastro-esophageal reflux (GER), which raises the question of the need for a fundoplication at the time of the gastrostomy insertion. When a gastrostomy is indicated, we generally use the open Stamm method to avoid abdominal CO2 insufflation that may affect venous return to the heart and cause hypercapnia and, because GER tends to resolve in infants and young children, we rarely perform a fundoplication at the time of gastrostomy preferring to use gastro-jejunal (GJ) feeding instead for patients with clinically significant GER. The purpose of this study was to evaluate the subsequent course of a cohort of infants and children with CHD following open Stamm gastrostomy without fundoplication.
Methods: We reviewed our experience with all CHD patients who underwent feeding gastrostomy placement from January 1, 2004 to April 7, 2015. We examined demographic data, cardiac diagnoses, operative details, post-operative complications, and the need for GJ feeding or fundoplication.
Results: An open Stamm gastrostomy was performed in 111 patients. Five additional patients had a fundoplication at the time of gastrostomy placement. Median age at surgery was 37 weeks (range 3 weeks to 13.7 years); average weight was 5.3 ±4.9 kg. Forty-eight patients (43%) had single ventricle physiology, 50 (45%) had biventricular physiology, and 13 (12%) had cardiomyopathy. Thirty-four (30%) patients experienced a total of 37 minor complications, which included tube dislodgement after maturation of the stoma (20), superficial surgical site infection (13), mechanical failure (3), and bleeding (1). Three (3%) patients experienced a major complication defined as a need for return to the OR or peri-operative death (<30 days). Only three (3%) patients required a subsequent fundoplication. At last follow-up (median 7.2 months, range 2 days-6 years), 56 of the 90 (62%) surviving patients continue to receive gastrostomy feeds, of those 7 (13%) patients continue to require GJ feeds.
Conclusion: Children with CHD tolerate an open Stamm gastrostomy well with minimal major complications. GER in CHD patients frequently resolves over time and patients seldom require a subsequent fundoplication. Our experience supports very selective use of fundoplication in infants and children with CHD who require a feeding gastrostomy.