Page 134 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

and did not use MII-pH measurements. 11 Based on our results with MII-pH measurements in a prospective cohort (chapter 5), we conclude that GP was not associated with an increase in GER.
In current literature, there are conflicting reports regarding the association between delayed GE and GER, possibly due to varying methods of GE assessment. 24-26 In chapter 5, a postoperative delay in GE was correlated with an increase in total acid exposure. This may partly explain why esophageal acid exposure increases in some of the patients after GP, while it diminishes in others. Hypothetically, delayed GE may accentuate GER by prolonging transient lower esophageal sphincter relaxations and increasing the volume of the refluxate.
Although GP does not induce GER, a large part of the children after GP do have GER, either pre-existent or newly developed. 27 There are several options for management of post-gastrostomy GER, highlighted by the small percentage of patients who later required antireflux surgery in our long-term follow-up study (chapter 3). These results justify that routine fundoplication in present day is no longer used as a standard procedure in children with preoperative pathological GER undergoing GP. Furthermore, routine 24-hour pH monitoring before GP does not result in a reliable prognostic value for the development of postoperative GER and is therefore no longer required in routine preoperative workup.
HRQoL plays a particularly essential role in the pediatric population undergoing GP, a heavily affected group of children. In this thesis patients improved mainly in the social domain of HRQoL while overall HRQoL did not change. These patient reported outcomes are not easily translated towards improvements in our daily practice. They can, however, be an indication of ‘how well we do’. Additionally, these data can be helpful for treating physicians in providing information towards parents when children are referred for GP.
Conclusion
In conclusion, in children who are dependent on a gastrostomy tube for enteral feeding, GP is an efficient way of providing weight gain in the long term. Laparoscopic GP carries a lower risk of major complications and reoperations compared to the percutaneous endoscopic technique. GP may increase the child’s social HRQoL. The possibility that GP causes delayed GE should be recognized by pediatric surgeons, even though the exact mechanism of this relation remains to be clarified. In contrast to previous reports, GP did not cause gastroesophageal reflux. In some children, gastrostomy fails, characterized by feeding intolerance and recurring minor complications with the gastrostomy tube. Therefore, consultations with specialized outpatient care units are important for adequate
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