Total esophagogastric dissociation: 10 years' review

Physical outcome and quality of life after total esophagogastric dissociation in children with severe neurodisability and gastroesophageal reflux, from the caregiver's perspective

“…We believe that in NI children with GORD, the TOGD should be performed as primary procedure instead of fundoplication because it is associated with better results, and the fundoplication in this specific group of patients has higher failure rate [1][2][3][4][5][7][8][9][10][11]. Therefore, TOGD was performed as primary procedure in 16 children.…”

“…Published literature suggests failure rates of 12% to 45% (failure being defined as the recurrence of GORD) [1][2][3][4][5][7][8][9][10][11][12] for primary fundoplication and 20% to 28% [3,5,13,14] for redo fundoplication in NI children. To overcome these shortcomings of fundoplication in NI children, Bianchi [1], in 1997, proposed total esophagogastric dissociation (TOGD) as an alternative to fundoplication, with Roux-en-Y esophagojejunostomy and nonrefluxing feeding gastrostomy.…”

Laparoscopic Proximal Roux-en-Y Gastrojejunal Diversion in Children: Preliminary Experience from a Single Center

“…1,2 Neurologically impaired children (NIC) frequently complain of various gastrointestinal (GI) symptoms and/or dysfunctions 3 : dysphagia, dysfunctional feeding patterns, swallowing difficulties, failure to thrive, recurrent chest infections, vomiting, retching, and gastroesophageal reflux (GER) have all been reported in NIC. [3][4][5][6][7][8][9][10] Approaching and treating these symptoms in NIC is extremely complex and frequently frustrating: A high rate of therapeutic failure and recurrence of the disturbances is reported, maybe due to a incorrect or incomplete diagnosis. [9][10][11] Treatment usually implies medical and surgical management of GERrelated symptoms, such as vomiting and aspiration pneumonia.…”

“…[3][4][5][6][7][8][9][10] Approaching and treating these symptoms in NIC is extremely complex and frequently frustrating: A high rate of therapeutic failure and recurrence of the disturbances is reported, maybe due to a incorrect or incomplete diagnosis. [9][10][11] Treatment usually implies medical and surgical management of GERrelated symptoms, such as vomiting and aspiration pneumonia. Moreover, efforts are aimed at ameliorating nutritional status, since this parameter has been proven to correlate significantly with the acute care hospitalization rate and overall morbidity.…”

“…Fundoplication is associated whenever a diagnosis of severe GER is confirmed. 9,13,14 Gastrostomy, associated with a complete or partial new high-pressure zone around the cardias, prevents GER from becoming worse. 12 Delayed gastric emptying is a commonly associated complaint, especially for those patients operated on with fundoplication, who may develop or show a persistence of postoperative retching that can increase the risk of wrap herniation, with or without disruption.…”