Is prophylactic fundoplication necessary? Laparoscopic fundoplication after gastrostomy vs non-gastrostomy patients.

Introduction: Laparoscopic fundoplication is a standard surgical procedure for gastroesophageal reflux disease (GERD). In Japan, it is frequently performed in children with severe motor and intellectual disabilities (SMID), many of whom also require gastrostomy for enteral nutrition. Prophylactic fundoplication during gastrostomy remains controversial due to concerns about post-operative complications and the limited number of patients who subsequently require fundoplication.

Patients and methods: This study retrospectively analyzed 47 cases of fundoplication at Tsukuba University Hospital from 2013 to 2024, comparing patients who underwent fundoplication after gastrostomy (post-G group) with those undergoing primary fundoplication (Primary group).

Results: Outcomes including operative time, blood loss, and post-operative hospital stay showed no significant differences between both groups. No cases required open conversion, and post-operative complication rate was not significantly different.

Discussion: Our findings indicate that fundoplication can be safely performed after gastrostomy without increased surgical risks, contradicting concerns about adhesions or operative difficulties. Previous studies have also failed to establish a direct link between gastrostomy and GERD progression. Given the low incidence of GERD requiring fundoplication after gastrostomy, routine prophylactic fundoplication is unnecessary.