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Byline: Ingrid Plantin (1), Einar Arnbjornsson (1), Lars-Torsten Larsson (1) Keywords: Gastrostomy; Laparoscopy; Gastroesophageal reflux; 24-h pH monitoring Abstract: The objective of the study was to assess the influence of a laparoscopic video-assisted gastrostomy on acid gastroesophageal reflux (GER). A prospective uncontrolled study included 23 neurologically disabled children, from 10 months to 15 years of age, all with severe nutritional problems and in need of a gastrostomy. They all had a history of clinical GER problems including vomiting, choking and chest infections. A 24-h pH monitoring was used for a quantitative assessment of GER the day before surgery and 12+-3 months (7--22 months) postoperatively. The gastrostomy was placed on the anterior wall of the stomach near the lesser curvature. The main outcome measure was the comparison of the pre- and postoperative 24-h pH monitoring and the reflux index (RI), i.e. the percentage of time with pH below 4. The results showed a non-significant reduction of RI from 6.8+-4.5 preoperatively to 3.7+-2.0 postoperatively. We conclude that a gastrostomy using the video-assisted technique and placing the stoma on the anterior wall of the stomach close to the lesser curvature does not cause aggravation of acid reflux. Author Affiliation: (1) Department of Paediatric Surgery, University Hospital, 221 85, Lund, Sweden Article History: Registration Date: 08/05/2006 Accepted Date: 08/05/2006 Online Date: 01/06/2006

Byline: A. Goessler (1,2), A. Huber-Zeyringer (1), M. E. Hoellwarth (1) Keywords: Gastroesophageal reflux; Spells; Epilepsy; Fundoplication; Recurrence; Neurologically impaired patients Abstract: In neurologically impaired patients (NIP), surgical management of gastroesophageal reflux disease (GERD) has become a widespread standard. Several follow-up studies have shown a high incidence of complications and recurrent reflux. As one of the possible causes epilepsy is mentioned repeatedly in the literature. The aim of this study was to determine the effective impact of epilepsy on the postoperative outcome by comparing results of our patients suffering from epilepsy to those without this disorder. From 1984 to 1999, a total of 45 NIP underwent antireflux surgery, including 20 patients suffering from epilepsy (EP) and 25 patients without this disorder (nEP). The existence of epileptic disorders, incidence of epileptic seizures and administration of anticonvulsatory drugs as well as results of diagnostic procedures, postoperative complications and incidence and time of recurrence of pathologic GER were recorded and analysed retrospectively. Preoperatively all patients had pathologic results in 24 h pH-monitoring. Median RI was 15.75 (EP, range 5.2--28.6) and 17.55 (nEP range 7.2--26.5). 12-months-postoperative 24 h pH-monitoring showed a median RI of 3.8 (EP range 1.3--25.6) versus a median RI of 3.3 (nEP range 0.7--26.3). During the long-term follow-up evaluation of 3.9 years, 17 EP suffered from persistent epileptic seizures despite medical treatment. 19 patients (42%) developed recurrent reflux. This included seven EP (35%) and 12 nEP (48%). The necessity of reoperation was higher in nEP (n = 5, 20%) than in EP (n = 1, 5%). This analysis did not show a significant correlation between recurrence of pathologic GER after fundoplication and the incidence of epileptic seizures. We consider our findings to strongly question the widespread opinion considering this correlation. We conclude, that cerebral seizures alone do not alter the operative outcome of antireflux surgery in NIP. Author Affiliation: (1) Department of Pediatric Surgery, University of Graz, Medical School, Auenbruggerplatz 34, 8036, Graz, Austria (2) Wilhelminenstrasse 100, 1160, Vienna, Austria Article History: Registration Date: 03/04/2006 Accepted Date: 03/04/2006 Online Date: 29/04/2006