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October 2013

To Fundo or Not to Fundo?

Author Affiliations
  • 1Department of Surgery, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts
JAMA Pediatr. 2013;167(10):896-897. doi:10.1001/jamapediatrics.2013.2402

Few questions can elicit such a polarized (and often visceral) reaction from surgeons, neonatologists, and gastroenterologists alike when debating management options for treating gastroesophageal reflux in infants with neurological impairment. Proponents of fundoplication cite the reported efficacy of the procedure for providing symptomatic relief, reducing reflux-associated hospital admissions, and improving quality of life for children with neurological impairment.1-5 Opponents cite excessively high perioperative complication rates and questionable long-term efficacy in this same cohort of patients, particularly with that surrounding aspiration pneumonia and other reflux-related respiratory sequelae.6-9 What is perhaps even more controversial is whether fundoplication should be performed in infants who require an operative procedure for feeding access but where the course and severity of reflux has yet been established. In other words, should a fundoplication be performed in these high-risk infants prophylactically at the same time they are undergoing a gastrostomy?

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