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

Emily T. Durkin, Mary K. Schroth, Margaret Helin, Aimen F. Shaaban*

*Corresponding author for this work

Research output: Contribution to journalArticle

31 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2031-2037
Number of pages7
JournalJournal of Pediatric Surgery
Volume43
Issue number11
DOIs
StatePublished - Nov 1 2008

Keywords

  • Aspiration
  • Enteral feeding
  • Morbidity/Mortality
  • Neuromuscular disorders
  • Nutrition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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