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Fundoplication consideration
Pergunta
What is a good age and/or weight to have stomach surgery for reflux?
Resposta dos nossos peritos
Most babies outgrow reflux. Children with CdLS often don't outgrow it. We do surgery when medical therapy fails. Failure includes: Growth failure from vomiting Respiratory disease from GER Refractory esophagitis on biopsy I would do aggressive medical therapy first, including medication and dripping feeds into the stomach or small intestine. The smaller you are and the more “complicated” a patient you may be, the worse you do with surgery. A fundoplication has at least a 20% serious complication rate in children with special needs.
CP/TK 7-13-10
Aprovado porClinical Advisory Board (CAB)
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Recomendação(ões)
Reflux
R32
Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
R33
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
R34
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
R35
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.
