WOFAPS 2025 8th World Congress of Pediatric Surgery

Yasir Alkhatib, Nisha Shan, Federica Rossi, Giampiero Soccorso

Birmingham Children's Hospital

Purpose
Feeding dysfunctional behaviours (FDB), like food refusal or selective eating, are common in children with Autism Spectrum Disorder (ASD), Trisomy-21 (T21), Cornelia de Lange Syndrome (CdLS), and other neurodevelopmental conditions. These children may experience worsening dysphagia after laparoscopic Nissen fundoplication (LNF) for gastro-oesophageal reflux disease (GORD). This study evaluates the impact of concurrent gastrostomy tube insertion (GTi) during LNF in children with FDB who feed orally.

Method
This is a retrospective clinical study conducted between 2014 and 2025. Out of a total of 179 LNF performed, 15 patients (median age: 6.6 years; range: 1–13 years) were identified as having FDB associated with ASD, T21 or CdLS. The primary objective was to assess the impact of GTi on patients and their caregivers, including factors such as acceptance, compliance, and the overall necessity of this additional procedure. The secondary objective was to evaluate the outcomes of patients with FDB who did not receive a GTi.

Results
Eleven patients (79%) received concurrent GTi. At the 12-month follow-up, three of these patients remained dependent on the Gt due to worsened feeding issues. Eight patients returned to their oral intake and had their Gt removed within 12 months postoperatively. Among the four patients who did not receive a GTi, one experienced postoperative feeding difficulties that required five days of intravenous fluids and resulted in a delayed discharge. Two patients resumed oral feeding without any complications. One child with ASD needed a delayed GTi due to worsened FDB.

Conclusion
Concurrent GTi during LNF proved beneficial for a limited subset of FDB patients, with justification in only 3 out of 11 (27%). While GTi may aid recovery in specific cases, it is not recommended as a routine procedure. A thorough multidisciplinary preoperative assessment and individualized planning are crucial to prevent unnecessary interventions and achieve the best possible outcomes.