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Esophagogastric separation for failed fundoplication in neurologically impaired children

Saleem Islam1, Daniel H Teitelbaum, William L Buntain

  • 1Section of Pediatric Surgery, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI 48109-0245, USA.

Journal of Pediatric Surgery
|March 16, 2004
PubMed

Insights

Esophagogastric separation (EGS) offers a promising solution for recurrent gastroesophageal reflux (GER) in neurologically impaired children after failed fundoplication. This procedure effectively manages GER, improving feeding tolerance and outcomes in this challenging patient group.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neurology

Background:

  • Recurrent gastroesophageal reflux (GER) is a significant challenge in severely neurologically impaired children, often inadequately managed by repeat fundoplication or gastrojejunostomy (GJ) tubes.
  • Failed fundoplication in this population leads to persistent symptoms like emesis, feeding intolerance, failure to thrive, and recurrent pneumonias.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of esophagogastric separation (EGS) as an alternative surgical approach for managing recurrent GER in severely neurologically impaired children with previously failed fundoplications.

Main Methods:

  • A retrospective review of medical records for 10 pediatric patients who underwent EGS for recurrent GER after failed fundoplication.
  • Data collected included patient diagnosis, preoperative conditions, surgical details, postoperative complications, and long-term outcomes.

Main Results:

  • All 10 patients had prior failed fundoplications and relied on tube feedings; 8 experienced failure to thrive and 5 had recurrent pneumonias.
  • No recurrent GER was observed post-EGS. Nine surviving children tolerated bolus gastrostomy feedings, a significant parental advantage.
  • The most common postoperative issue was salivary secretion intolerance (5/10); two patients required re-exploration for complications.

Conclusions:

  • Esophagogastric separation (EGS) presents a viable and effective alternative for managing refractory gastroesophageal reflux in severely neurologically impaired children who have not benefited from fundoplication.
Abstract

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