The role of combining anti-reflux and anti-drooling surgery in neurologically impaired children with chronic lung aspiration.

Abstract

Background: Hospitalizations for children with neurological impairments (NI) are frequently caused by chronic lung aspiration (CLA). Gastroesophageal reflux disease (GERD) and posterior drooling are two of the causes of CLA. Combination of anti-reflux procedure, i.e. Nissen fundoplication (NF), and anti-drooling surgery, i.e. subtotal functional sialoadenectomy (SFS), could effectively address both components of CLA. This study presents outcomes of the combined surgical treatment, especially focusing on long-term results. The aim of this article is to present our experience using a combination of NF and SFS as treatments for CLA caused by refractory GERD and drooling in pediatric patients with NI.

Methods: Retrospective analysis of consecutive patients treated in our pediatric tertiary center (period: 2012-20). Inclusion criteria: NI patients with CLA, simultaneous refractory GERD and drooling, minimal follow-up ≥12 months.

Results: Seventeen patients included (12 males): all patients had dysphagia and fifteen (88%) had vomiting/regurgitation. Four patients (24%) had ≤1 aspiration pneumonia/year, while 13 (76%) had recurring episodes (≥2 per year). The median age at surgery was 8.2 years old (0.8-18.5). Three patients (18%) had early major complications (Clavien-Dindo ≥IIIa). After surgery, study population showed a significant decrease in vomiting/regurgitation (P=0.0004), posterior drooling (P=0.0039), and mean episodes of pneumonia/year (P=0.0009). One patient (6%) needed re-do fundoplication for GERD recurrence. One patient (6%) had tracheostomy. No surgery related mortality was recorded.

Conclusions: The combination of NF and SFS offers a chance to face up to chronic pulmonary aspiration, proving to effectively treating both GER and posterior drooling, with an acceptably low complication rate.