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Pediatric Surgery International
Published in: Pediatric Surgery International 2/2017

01-02-2017 | Original Article

Fundoplication with gastrostomy vs gastrostomy alone: a systematic review and meta-analysis of outcomes and complications

Authors: Brendan K. Y. Yap, Shireen Anne Nah, Yong Chen, Yee Low

Published in: Pediatric Surgery International | Issue 2/2017

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Abstract

Purpose

We compare the outcomes of fundoplication with gastrostomy vs gastrostomy alone and review the need for subsequent fundoplication after the initial gastrostomy alone.

Methods

We searched studies published from 1969 to 2016 for comparative outcomes of concomitant fundoplication with gastrostomy (FGT) vs gastrostomy insertion alone (GT) in children. Gastrostomy methods included open, laparoscopic, and endoscopic procedures. Primary aims were minor and major complications. Secondary aims included post-operative reflux-related complications, fundoplication specific complications, and need for subsequent fundoplication after GT.

Results

We reviewed 447 studies; 6 observational studies were included for meta-analysis, encompassing 2730 children undergoing GT (n = 1745) or FGT (n = 985). FGT was associated with more minor complications [19.9 vs 11.4%, OR 2.02, 95% confidence interval (CI) 1.43–2.87, p ≤ 0.0001, I 2 = 0%], minor complications requiring revision (6.8 vs 3.0%, OR 2.27, 95% CI 1.28–4.05, p = 0.005, I 2 = 0%), and more overall complications (21.3 vs 12.0%, OR 1.99, 95% CI 1.43–2.78, p < 0.0001, I 2 = 0%). Incidence of major complications (1.8 vs 2.0%, OR 1.39, 95% CI 0.62–3.11, p = 0.42, I 2 = 5%) and reflux-related complications (8.8 vs 10.3%, OR 0.75, 95% CI 0.35–1.68, p = 0.46, I 2 = 0%) in both groups was similar. Incidence of subsequent fundoplication in GT patients was 8.6% (mean).

Conclusions

Gastrostomy alone is associated with fewer minor and overall complications. Concomitant fundoplication does not significantly reduce reflux-related complications. As few patients require fundoplication after gastrostomy, current evidence does not support concomitant fundoplication.
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Metadata
Title
Fundoplication with gastrostomy vs gastrostomy alone: a systematic review and meta-analysis of outcomes and complications
Authors
Brendan K. Y. Yap
Shireen Anne Nah
Yong Chen
Yee Low
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 2/2017
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-016-4028-5

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