This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Survival of children following Nissen fundoplication. BJS 2011; 98: 680-685.
Published: 23rd February 2011
Authors: R. Wockenforth, C. S. Gillespie, B. Jaffray
Background
Analyses of survival after fundoplication in childhood are often restricted to 30‐day mortality, or to the neurologically impaired. The objective of this study was to report actuarial survival and variables associated with mortality for all children undergoing fundoplication.
Method
This was a prospective observational study of fundoplication surgery by one surgeon; the endpoint was survival. Using a Cox proportional hazards model, gastrostomy, neurological status, tracheostomy, congenital cardiac disease, syndromic status, presence of congenital anomaly, other chronic disease, weight z‐score at time of surgery, need for revisional fundoplication, use of laparoscopic surgery, gastric drainage procedures, age and sex were assessed for their influence on survival.
Results
Two‐hundred and thirty children underwent 255 fundoplications at a median age of 3·6 years. Forty‐six children (20·0 per cent) died during a median follow‐up of 2·8 (range 0·5–11·2) years. Statistical modelling showed gastrostomy (relative risk of death 11·04, P < 0·001), cerebral palsy (relative risk 6·58, P = 0·021) and female sex (relative risk 2·12, P = 0·015) to be associated with reduced survival. Revisional fundoplication was associated with improved survival (relative risk of death 0·37, P = 0·037). Survivors had significantly higher weight z‐scores (−1·4 versus − 2·9 for those who died; P = 0·001). The 5‐year survival rate after fundoplication for children with cerebral palsy and gastrostomy was 59 per cent.
Conclusion
Survival of children following fundoplication is related principally to the presence of a gastrostomy and neurological status. Estimates of children's life expectancy should take account of the poorer survival of neurologically impaired children who undergo fundoplication, presumably due to the related co‐morbidities that lead to a gastrostomy. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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