Total oesophagogastric dissociation: experience in 2 centres

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Neurology

Background:

• Neurologically impaired (NI) children exhibit a higher prevalence of gastroesophageal reflux (GER).
• Many NI children with GER require surgical intervention for effective management.
• Failed fundoplications necessitate rescue surgeries in a subset of these patients.

Purpose of the Study:

• To evaluate the safety and efficacy of total oesophagogastric dissociation (TOGD).
• To assess TOGD as a primary surgical approach versus a rescue procedure for GER in NI children.
• To analyze surgical outcomes, morbidity, and long-term benefits in this patient population.

Main Methods:

• Retrospective review of 50 NI children undergoing TOGD.
• Categorization of procedures into primary (34 cases) and rescue (16 cases) groups.
• Analysis of operative outcomes, complications, hospital stay, and long-term follow-up data.

Main Results:

• No operative mortality observed.
• Limited surgery-related morbidity including subphrenic collection, dehiscence, stenosis, and bowel obstruction.
• Successful gastrostomy feeding established within 3-5 days, with a mean hospital stay of 10.9 days.
• Significant long-term benefits including no GER recurrence, improved oral feeding, enhanced health, and reduced aspiration, infections, and hospitalizations.
• Late deaths occurred due to underlying condition deterioration, with slightly higher rates in the rescue group.

Conclusions:

• Total oesophagogastric dissociation is a safe and versatile procedure for managing GER in NI children.
• TOGD is recommended as a primary intervention for severely NI children with GER, oropharyngeal incoordination, and enteral feeding dependence.
• Rescue TOGD procedures present higher morbidity risks due to prior surgeries and anatomical challenges.