Total esophagogastric dissociation: single center experience.
Aim
Fundoplication fails in approximately 20% of children with severe neurodisability. We aimed to evaluate total esophagogastric dissociation (TOGD) as a primary procedure and as a ‘rescue’ procedure for severely neurologically impaired children with significant swallowing discoordination and gastroesophageal reflux disease.


Methods
Casenotes of 40 children with severe neurodisability who underwent TOGD between 2005 and 2015 were retrospectively reviewed. Of these, 33 were primary procedures and 7 were ‘rescue’ procedures following failed fundoplication.


Results
Median age at surgery was 3 years 7 months (range 1 month to 13 years 11 months). Preoperatively, all children had symptoms of regurgitation, retching or vomiting and 70% of children had an unsafe swallow. There were 5 early complications related to surgery in 4 children requiring surgical intervention. One child died following relaparotomy for esophagojejunal anastomotic breakdown because of multiorgan failure. Gastrostomy feeding was established by a median of 6 days (range 2 to 25 days) and median hospital stay was 10 days (range 4 to 280 days). There were 5 late complications. Median follow-up was 13 months (range 1 month to 8 years 4 months). All children have had resolution of gastroesophageal reflux. Thirteen percent of children experience bloating or pain on feeding and 26% of children experience retching unrelated to gastroesophageal reflux. There were 8 late deaths unrelated to surgery.


Conclusion
TOGD should be considered as a primary and definitive procedure in selected severely neurodisabled children who are at higher risk of failure of fundoplication, recurrent aspiration and a reduced quality of life.
['Chhabra|Sumita|S|', 'Nedea|Anca-Mihaela|AM|', 'Kauffman|Lisa|L|', 'Morabito|Antonino|A|']
D000293:Adolescent D000714:Anastomosis, Surgical D002648:Child D002675:Child, Preschool D003680:Deglutition Disorders D013505:Digestive System Surgical Procedures D004947:Esophagus D005260:Female D005764:Gastroesophageal Reflux D006801:Humans D007223:Infant D007902:Length of Stay D008297:Male D009422:Nervous System Diseases D011788:Quality of Life D012189:Retrospective Studies D013270:Stomach
Esophagogastric dissociation Severe neurological impairment Gastroesophageal reflux