Total esophagogastric dissociation: single center experience

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Neurodisability Research

Background:

• Fundoplication has a high failure rate (approx. 20%) in children with severe neurodisability.
• These children often suffer from significant swallowing discoordination and gastroesophageal reflux disease (GERD).

Purpose of the Study:

• To evaluate total esophagogastric dissociation (TOGD) as a primary surgical procedure.
• To assess TOGD as a rescue procedure following failed fundoplication in severely neurologically impaired children.

Main Methods:

• Retrospective review of 40 children with severe neurodisability who underwent TOGD between 2005 and 2015.
• Analysis of 33 primary TOGD procedures and 7 rescue procedures after failed fundoplication.

Main Results:

• All patients achieved resolution of GERD.
• Early complications occurred in 4 children (requiring surgical intervention), with one mortality due to anastomotic breakdown.
• Late complications included feeding intolerance (13%) and retching (26%); 8 late deaths occurred, unrelated to surgery.

Conclusions:

• TOGD is a safe and effective primary procedure for selected severely neurodisabled children.
• Consider TOGD for children at high risk of fundoplication failure, recurrent aspiration, and reduced quality of life.