Total oesophagogastric dissociation: experience in 2 centres

Pediatric surgeons and gastroesophageal reflux

“…When more long-term studies will be available, it is tempting to think that this may have a role for those patients in whom several fundoplications have been ineffective or in some selected cases as a first option [26][27][28].…”

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

“…Because it often cannot be controlled via conservative or medical methods of management, antireflux surgery may be indicated. Studies have shown that fundoplication is not adequate for this group of patients and has a high failure rate [1][2][3][4][5][7][8][9][10]. Total esophagogastric dissociation has been suggested as an alternative approach.…”

“…Gastroesophageal reflux disease (GORD) is a common pediatric problem that is particularly frequent in neurologically impaired (NI) children [1][2][3][4][5][6], occurring in up to 70% [6]. In nondisabled children, the natural history is for GORD to improve and eventually resolve.…”

“…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.…”

“…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. Total esophagogastric dissociation aims to eliminate the possibility of GORD recurrence by completely detaching the esophagus from the stomach while the child is still able to swallow saliva and to take small amounts of food orally [1,2]. There has been a mixed response to TOGD, with some authors suggesting that the procedure should only be used as a rescue for failed fundoplication [6], whereas others believe that the TOGD should be considered as a primary option for the resolution of GORD in the neurologically intact children [2].…”