Outcomes of paediatric fundoplication stratified by subtype of neurological impairment

•Outcomes of 144 fundoplications were analysed and stratified for neurological impairment subtype.•84 % had successful outcomes with low surgical morbidity: fundoplication should therefore be offered as an alternative to jejunal feeding during counselling.•There was no significant difference in failure between neurological groups in this sample size. Jejunal feeding is increasingly seen as an alternative to fundoplication in neurologically impaired children. However, fundoplication may offer important advantages. This study aimed to determine: (i) contemporary outcomes of fundoplication from a sub-specialised service; and (ii) whether outcomes were influenced by neurological characteristics. Single-centre retrospective review of consecutive children undergoing fundoplication by three surgeons over five years (2017–2022) using a standardised technique. Children were stratified as neurologically unimpaired, static brain injury, neuromuscular condition or neurodegenerative impairment. Failure was defined as a requirement for subsequent jejunal feeding or further surgery. Data are presented as median (IQR) unless stated. Comparisons used Fisher's test. 144 children underwent fundoplication at 1.9 years (1–5 years): 97/144 (67 %) had neurological impairment. Surgery was completed laparoscopically 128/144 (89 %) and converted in 9/137 (7 %). 84/144 (60 %) underwent concomitant gastrostomy formation. At 35 months (22–47), absolute failure was 16 % (23/144). Failure was higher in those with neurodegenerative conditions (not significant). Persistence of symptoms was noted in 23/144 (16 %). Two (1.4 %) required reoperation (