Health-related quality of life of children with gastro-oesophageal reflux disease after nissen fundoplication and gastrostomy tube insertion - A retrospective observational study

Background: Severe gastro-oesophageal reflux disease (GERD) is associated with a poor health-related quality of life (HRQoL). Nissen fundoplication is the most common surgical procedure for patients with GERD. A feeding gastrostomy tube may be inserted at the same time in selected patients where there are unsafe swallowing and/or feeding difficulties. The goals of surgery are to eliminate symptoms, prevent reflux complications and ultimately improve the quality of life. The main objective of this study was to assess the HRQoL of children with GERD after Nissen fundoplication and gastrostomy tube insertion. Materials and Methods: This was an observational retrospective cohort study at two private, not-for-profit tertiary hospitals in Nairobi. The study population included children under 18 years of age with GERD who had Nissen fundoplication with or without gastrostomy tube insertion from January 2010 to December 2020. The quality of life was assessed from the caretakers using the Paediatric Quality of Life Inventory applied through a telephone call. Data analysis was done using SPSS version 26. The HRQoL was summarised using mean and standard deviation (SD) with a 95% confidence interval (CI) around the scores. Independent samples t-test was conducted to compare the means of HRQoL for gender, complications and comorbidities. Spearman's correlation was done for HRQoL and age. Results: Eighty-two children were included in the study. Eighty-four per cent had comorbidities, with almost three-quarters of them having neurological impairment. Majority (91%) had open Nissen fundoplication, while 9% had laparoscopic Nissen fundoplication. One-third of these children reported complications post-procedure. Nissen fundoplication failure rate was 10%. Two-thirds had a concurrent gastrostomy tube insertion. The global mean HRQoL score was 75.8 (SD: 23.5, 95% CI: 70.4–81.2). Gastrostomy tube insertion had no impact on the quality of life. Children with neurological impairment had significantly lower quality of life than those without neurological impairment. Conclusion: The global score of the HRQoL following Nissen fundoplication in this cohort of children was 75.8. Further studies to reduce the proportion of children who experience complications postoperatively in this setting are required.