Considerations and experiences on surgical approach in the disabled child

Some pathologies linked to possible surgical treatments are quite common in the disabled patient: reflux disease (75% of cases), dysphagia, malnutrition, sialorrhoea, persistent constipation. Gastroduodenal CT scan, esophageal endoscopy, Phmetria should be used to assess the reflux, in order to make a distinction between surgical treatments that can be decisive and those that could be recurring: in the second case it is better to provide omeprazole. Dysphagia and malnutrition have a much better prognosis and evolution, since it is possible to recur to PEG that can allow a partial (but rewarding) normal feeding by mouth. Another useful strategy to avoid malnutrition is feeding through PEG during the night and feeding by mouth during the day. You have to keep in mind that PEG presents some peculiar technical difficulties in the preterm babies with low weight, in patients who have undergone abdominal surgery for other pathologies and those who have severe scoliosis. In some selected cases PEG can be turned into digiunostomy. Sialorrhoea, that may cause aspiration pneumonia, can be controlled by binding salivary ducts. In our experience we got satisfactory results with the trans-oral removal of the sublingual glands. Finally, the constipation with resistance to the new laxatives (Macrogol) is treated with percutaneous cecostomy that allows effective antegrade colonic lavage.

Keywords: Severe disability, reflux disease, malnutrition, dysphagia, sialorrhoea, persistent constipation, PEG

Francesco De Peppo, Riflessioni ed esperienze sull’approccio chirurgico al bambino disabile in "CHILD DEVELOPMENT & DISABILITIES - SAGGI" 3/2010, pp 35-42, DOI: 10.3280/CDD2010-003006