J. A. Sobrino1, H. Alemayehu1, J. A. Sujka1, L. A. Benedict1, T. A. Oyetunji1, S. D. St.Peter1, J. D. Fraser1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Department Of Surgery,Kansas City, MO, USA
Introduction:
Failure of fundoplication has been linked to technical and patient-related matters. One clinical concern that persists is the early initiation of bolus feeding leading to retching and wrap disruption. Here, we evaluate this relationship in fundoplication performed with minimal dissection of the hiatus.
Methods:
A retrospective review of patients undergoing laparoscopic fundoplication with or without gastrostomy was performed from 2014 to 2016. Demographics, details of the operation, details of post-operative feeding regimen, and one-month follow up were obtained. All values are reported as medians with interquartile ranges (IQR).
Results:
Over 2 years, 58 patients were included. The median age was 200 days (IQR 118, 538). The most common preoperative symptom was retching in 58% of the patients (n=33).The median operative time was 73 minutes (IQR 57, 115). Majority of the patients (67%, n=39) had a gastrostomy tube placed during their fundoplication and 8 patients (14%) already had a gastrostomy tube.
Feeds were initiated on the day of surgery in 97% of patients, with 28 patients (51%) receiving bolus feeds and 26 (48%) on continuous feeds. Three patients (10%) on continuous feeds were started at their goal rate. Median time to conversion from continuous feeds to bolus was 2 dys (IQR 1, 6 dys) for those that were on bolus feeds pre-operatively.
Median follow up time was 1.87 mo (.83, 2.17 mo). Twenty-three patients (39.6%) reported retching, with no between those on continuous vs bolus feeds (34.4% vs 44.8%, p=0.59). 18 patients (37%) had ongoing reflux symptoms prompting further work up. One patient from the bolus feeding group was diagnosed with a wrap disruption – a non-significant difference between the groups (3% vs 0%, p=1). This patient’s symptoms were controlled and she was allowed to gain weight with a successful repair 18 months later.
Conclusion:
Bolus feeding after laparoscopic fundoplication does not lead to increased rates of wrap disruption.