"Total Gastric Dissociation (TGD)" in difficult clinical situations

Since the first report by Bianchi in 1997, TOGD has been found to be safe and effective in patients with gastro-oesophageal reflux (GOR) with neurological impairment. This paper explores the versatility of total gastric dissociation (TGD) in difficult clinical situations.

The medical records of 11 neurologically normal children treated with TGD and gastrostomy after failure of conventional procedures between 1999 and 2004 were reviewed with respect to demographic data, initial diagnosis, previous operations, postoperative complications, feeding pattern, and follow-up.

There were 7 males and 4 females. The mean age at operation was 52.7 months (24 to 72 m). The indications were severe colo-oesophageal reflux in 3; 1 post-fundoplication necrotic stomach; 1 gastric remnant after subtotal gastrectomy for bleeding; 1 microgastria; 2 with severe oesophageal obstruction following repeated failed repair of congenital stenosis of the oesophagus and after fundoplication; 1 congenital short oesophagus with left-sided congenital diaphragmatic hernia; and 2 with severe dysfunctional oesophagus following repair of congenital tracheo-oesophageal cleft. Full oral or gastrostomy feeding was established by the 5th postoperative day. The average follow-up was 47.2 months (24-72 months). There were 4 late deaths in the group: 2 with respiratory failure, 1 with sepsis secondary to peritonitis (small bowel herniation into the thorax) and 1 with pneumococcal infection. Seven patients are alive and thriving with markedly reduced episodes of chest infections and hospitalizations.

In this study TGD presented with no peri-operative morbidity and mortality and had good long-term results. The procedure offers a safe alternative for neurologically normal children after the failure of conventional surgical procedures.