Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?

Long-term and ‘patient-reported’ outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child

“…This hypothesis is somewhat supported by the lower postoperative use of antireflux medication, but given that these therapies are often liberally prescribed in these patients, this surrogate marker of failure does not permit firm conclusions. These long-term data are in keeping with previous shorter-term studies of TOGD and open fundoplication that demonstrate at least equivalent or possibly improved outcomes with TOGD in severe ND [20,21]. Furthermore, the 'failure' rate of 21% and reoperation rate of 13% in LapFundos are very similar to other contemporary series that include a good follow-up length, thus suggesting that our data are robust and generalizable to the procedure [11,15,12].…”

“…In this comparison, one surgeon performed surgery in each group: this has the advantage of minimizing the mix of performance biases found in studies involving multiple surgeons [28]. The follow-up period is a significant strength and longer than previous studies [20,21]. The weaknesses of this study are largely a consequence of the first part's retrospective nature and aspects of methodology such as lack of randomization.…”

“…First proposed by Bianchi in 1997 as a salvage operation after failed fundoplication, TOGD has been used as a primary procedure and shown to compare favourably to fundoplication in terms of reduced failure rate, improved postoperative nutrition, reduced respiratory complications and improved quality of life [17,20,21]. Furthermore, carers report that TOGD has a considerable positive impact on the physical well being of the child with ND and appears to make caring for the child easier [22].…”

Long-term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children

“…In the subgroup of children with long-term recurrence, often because of increased spasticity, esophagogastric dissociation, as reported by Bianchi [20] probably is the reoperation of choice. Some teams propose this Bianchi esophagogastric dissociation as a first procedure [21,22], but considering our results with 14 of 15 GERD cases among NI children controlled by a laparoscopic fundoplication, we concluded that the Bianchi procedure, performed through a laparotomy, must be reserved for the second procedure if needed.…”

Laparoscopic total esophagogastric dissociation

“…The failure of fundoplication to control the GER occurs in a minority of patients, but these patients have frequently delicate neurologic, respiratory, and/or nutritional status [3][4][5]. These patients could benefit from the advantages of laparoscopic approach: the reduced postoperative pain, the better respiratory function, and the reduced adhesive disease.…”