ABSTRACT
A fundoplication may result in gagging, retching, and gas bloating in the early postoperative period. This usually subsides in 4 to 6 weeks in the majority of patients. One of the most common troublesome late complications is mechanical small bowel obstruction. In neurologically impaired patients, this may be fatal because of the delay in recognizing the condition. Wrap herniation, or "slipped Nissen," is another possible complication, which accounts for the largest cause of recurrence of reflux and reoperation. Especially in neurologically impaired children, the recurrence rate is as high as 25%, and relapse of symptoms is noted in 71 % of patients (5). Various factors playa role in predisposing neurologically impaired children to have reflux. External factors include scoliosis, chronic recumbency, and aerophagia with increased intra-abdominal pressure. Internal factors include gut dysmotility with gastric stasis and constipation. Recently, laparoscopic fundoplication has become a common surgical procedure for treating GERD in children (6).
