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Single-stage procedure combining Nissen Fundoplication and Subtotal Functional Sialoadenectomy for neurologically impaired children with Chronic Lung Aspiration: “the best with the least” approach
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  • Angelo Zarfati,
  • Sonia BATTAGLIA,
  • Daniela CAMANNI,
  • Ottavio ADORISIO,
  • Francesco DE PEPPO
Angelo Zarfati
Ospedale Pediatrico Bambino Gesu

Corresponding Author:[email protected]

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Sonia BATTAGLIA
Ospedale Pediatrico Bambino Gesu
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Daniela CAMANNI
Ospedale Pediatrico Bambino Gesu
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Ottavio ADORISIO
Ospedale Pediatrico Bambino Gesu
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Francesco DE PEPPO
Ospedale Pediatrico Bambino Gesu
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Abstract

INTRODUCTION: Chronic Lung Aspiration (CLA) is a major cause for repeated hospitalizations in neurologically impaired (NI) children. This can be due to both gastroesophageal reflux disease (GERD) and drooling. Successful surgical treatment of GERD alone does not guarantee the prevention of further episodes of inhalation. The aim of the study was to analyze our experience with combined surgical treatment of GERD and drooling, consisting in a single-stage procedure combining Nissen Fundoplication (NF) and Subtotal Functional Sialoadenectomy (SFS). METHODS: retrospective analysis of consecutive patients treated in our pediatric tertiary center (period: 2012-20). Inclusion criteria: NI pediatric patients with CLA, with simultaneous refractory GERD and drooling, minimal follow-up (FU) ≥12 months. RESULTS: 17 patients were included. Before surgery, 4 (24%) had ≤1 aspiration pneumonia/year, while 13 (76%) had recurring episodes (≥2 per year) before surgery. The median age at surgery was 8.2 years-old (range: 0.8-18.5). Three patients (17%) had early major complications (Clavien-Dindo ≥IIIa). No surgery related death occurred. During the follow-up, the study population showed a significant decrease in vomiting/regurgitation (p=0.0004), drooling (p=0.0039), and mean episodes of pneumonia/year (p=0.0009). One patient (6%) needed to re-do fundoplication for GERD recurrence. One patient underwent tracheostomy due to respiratory failure. Conclusions: A combination of NF and SFS may be considered for NI patients with CLA caused by refractory GERD and drooling. This approach could effectively treat symptoms and slow respiratory deterioration in this high-risk subgroup of patients, reducing the rate of patients necessitating a tracheostomy to manage pulmonary secretions.