Weight Gain and Resource Utilization in Infants After Fundoplication versus Gastrojejunostomy

Background: The need for durable enteral access is common for children who do not tolerate gastric feeds. Due to a lack of guidelines, there is wide practice variation in the use of laparoscopic fundoplication (LF) versus gastrojejunostomy (GJ) tube insertion. Using weight gain as an objective proxy of adequate nutrition and healthcare utilization as a marker of caregiver burden, we sought to evaluate the difference in postoperative outcomes between LF and GJ.

Methods: A retrospective, cohort study was conducted to study patients ≤ 2 years who underwent LF or GJ between 2014-2019 at a single institution. Patient characteristics, change in weight one-year post-procedure and frequency of unplanned healthcare utilization encounters were collected and examined using univariate analysis and multivariate linear regression modeling.

Results: A total of 125 patients (50.4%LF, 49.6%GJ) were identified. Children treated with LF had significantly greater mean weight gain one-year post-procedure (4.3kg, SD1.7) compared to those treated with GJ (3.3kg, SD1.7) (p < 0.01). The GJ cohort had significantly more unplanned healthcare utilization encounters (4.2, SD3.4) compared to LF (3.0, SD3.1) (p=0.03). Furthermore, the GJ cohort underwent an average of 3.3 planned GJ exchanges within one-year post-procedure. Adjusted modeling demonstrated that on average, there was an additional 0.85-unit increase in weight-for-age Z-scores in the LF compared to the GJ cohort (p=0.01).

Conclusion: In the first year postoperatively, LF is associated with increased weight gain and fewer unplanned and overall healthcare encounters compared to GJ. Long-term outcomes including caregiver burden, post-procedural weight gain and specific quality of life measures must be prospectively studied to develop standardized guidelines for this common clinical scenario.