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Esophagogastric dissociation versus fundoplication: Which is best for severely neurologically impaired children?

C Gatti1, G F di Abriola, M Villa

  • 1Digestive Surgery Unit, Bambino Gesù Children's Hospital, Roma, Italy.

Journal of Pediatric Surgery
|May 1, 2001
PubMed

Insights

Esophagogastric dissociation (EGD) in neurologically impaired children (NIC) led to better nutritional outcomes and fewer respiratory infections compared to fundoplication and gastrostomy. EGD is a viable primary surgical option for these complex patients.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Nutritional rehabilitation

Background:

  • Neurologically impaired children (NIC) frequently experience feeding difficulties, reflux, and respiratory issues.
  • Traditional treatments like fundoplication and gastrostomy have limitations.
  • Esophagogastric dissociation (EGD) emerged as a potential alternative.

Purpose of the Study:

  • To compare the efficacy of EGD versus fundoplication and gastrostomy in NIC.
  • To evaluate nutritional status, respiratory health, and quality of life post-surgery.

Main Methods:

  • Prospective study of 29 NIC refractory to medical therapy.
  • Group A (n=12): fundoplication and gastrostomy. Group B (n=14): EGD.
  • Analysis of anthropometric, biochemical, infection rates, hospitalization, feeding time, and quality of life pre- and post-operatively.

Main Results:

  • Group B (EGD) showed significant improvements in nutritional parameters and quality of life compared to Group A.
  • EGD group experienced fewer respiratory infections, shorter hospital stays, and reduced feeding times.
  • Complications included bowel obstruction and anastomotic stricture in the EGD group; fundoplication group had more severe complications.

Conclusions:

  • EGD demonstrates superior outcomes in nutritional rehabilitation and quality of life for NIC.
  • EGD offers a significant reduction in respiratory infections and hospitalizations.
  • EGD is a recommended primary surgical approach for symptomatic NIC.
Abstract

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