Indications for total esophagogastric dissociation in children with gastroesophageal reflux disease

Abstract

Total esophagogastric dissociation (TED) is used to treat gastroesophageal reflux (GER) after failed fundoplication in neurologically impaired patients. It is now performed for some otherwise healthy patients with severe GER. In this procedure, the gastrointestinal tract is reconstructed in a non-physiological way with a Roux-en-Y esophagojejunal anastomosis and jejuno-jejunostomy. Although TED eliminates almost all GER, some patients experience late complications. In this review, we investigated the long-term outcomes after TED to determine the best indications. In total, 147 neurologically impaired patients and 28 neurologically normal patients were identified. The total rate of complications requiring re-operation was 17.2% in neurologically impaired patients and 32.1% in normal patients, both higher than the rates associated with fundoplication. Although most authors added pyloroplasty when there was a concern of gastric emptying, this sometimes caused bile reflux. Nutritional and metabolic complications, including dumping syndrome and chronic digestive malabsorption, were also reported to occur after TED. TED is an option for the treatment of neurologically impaired patients with recurrent GER after fundoplication or who are at a high risk of recurrence of GER with fundoplication. However, neurologically normal patients who have the ability to obtain nutrition orally should consider options other than TED, as postoperative complications are frequent.

Total Oesophagogastric Dissociation in Neurologically Impaired Children

“…In fact, the differences between the literature and our study in terms of early and late complications are not significant (P value of 0.590 and 0.606, respectively). The overall reoperation rate after dissociation in NI patients is reported to be 12.1% to 16.4% (25,27) in the literature and it was 20% in our series (P value ¼ 0.244). The recent meta-analysis by Lauriti et al (11) reports a total complication rate of 21.6 AE 2.8% after dissociation and a lower rate of 8.2 AE 8.3% after fundoplication, albeit the difference is not statistically significant between the 2 procedures (11).…”

“…Neither procedure relieves the child of severe GER and aspiration (11). Fundoplication in its various forms, of which Nissen fundoplication (open or laparoscopic) is the most common, is attempted to help alleviate the situation (11,25). It is unfortunate that relief often proves to be only temporary because of a high incidence of recurrence of reflux [16%–38% (4–11)] within 2 years of surgery.…”

Total Esophagogastric Separation in Neurologically Impaired Children: Outcome and Efficacy

“…These results are higher than Tanaka Y. et al [15] (17.2%) and Gatti C, et al, [16] (15.5%). This is explained by our low number of cases, although we have no mortality cases.…”

Modified Oesophago-Gastric Dissociation (M-OGD) — a technical modification

“…The median surgical time was 170 min (146-280), the median anaesthetic time, was 263 min (240-340), the median IOT intubation post-surgery was for 24 h (20-26), with a median of 4 days (2-5) in the high-dependency unit. The median time to enteral feeding was 3 days (2-5), and the median length of stay was 20 days (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). All patients healed well without any complications at the oesophagojejunal and the jejuno-jejunal anastomoses.…”

“…TOGD has been used more commonly in Europe [5][6][7], but there are only limited reports for this approach in the United States [8,9] or other non-EU [10,11] countries. However, for a very specific and complex patient population, this procedure has a high likelihood of permanently eliminating recurrent reflux and aspiration, and of improving the quality of life for the patients and their caregivers by reducing healthcare visits and hospital readmissions, and improving feeding habits [12].…”