A Perfect Storm of Complexity: Open Nissen Fundoplication as the Surgical Turning Point in a Multimorbid Child With Severe GERD-A Case Report

Background: Gastroesophageal Reflux Disease (GERD) is one of the most common gastrointestinal disorders seen in pediatric clinical practice, affecting an estimated 26.9% of infants aged 0 to 18 months. Children with severe neurologic impairment (NI) are especially at risk for failure to thrive, dysphagia, and GERD. For pediatric patients unresponsive to conservative treatments, fundoplication has become a widely accepted surgical option, with success rates ranging from 70% to 80%. Case Presentation: A 21-month-old boy was brought in with intractable vomiting, recurrent laryngeal swelling, severe failure to thrive, and dependence on a tracheostomy tube. His condition was further complicated by global neurodevelopmental delay and suspected mitochondrial disease. Over 18 months, he underwent procedures including supraglottoplasty, epiglottopexy, airway stenting, and laser debulking, none of which provided lasting relief. Ultimately, a definitive diagnosis of severe grade III–IV GERD was confirmed via barium contrast imaging. He then underwent open Nissen fundoplication with Stamm gastrostomy; postoperatively, vomiting stopped immediately, enteral feeding was successfully initiated and gradually increased, and his nutritional status steadily improved during follow-up. Discussion: Surgical treatment, such as gastrostomy and fundoplication, is generally reserved for children unresponsive to medication or those with potentially life-threatening complications. Nissen fundoplication has demonstrated consistent safety and effectiveness in controlling symptoms and enhancing the quality of life in affected children. Conclusion: This case underscores the often-overlooked yet critical role of GERD in recurrent laryngeal issues and confirms that open fundoplication with gastrostomy is a safe, effective, definitive treatment, even in complex pediatric cases.