Total Oesophagogastric Dissociation in Neurologically Impaired Children

Total Oesophagogastric Dissociation in Neurologically Impaired Children: 18 Years’ Experience and Long-Term Follow-Up: Objectives:

Total Oesophago-gastric Dissociation (TOGD) is an alternative antireflux surgery for neurologically impaired children because of a 16%-38% fundoplication failure rate. This study evaluates TOGD's feasibility and its long-term efficacy both as a Primary and as a ‘Rescue’ procedure after failed fundoplication.

Methods:

30 patients (18 male) who underwent TOGD between 2000 and 2018 in two Italian Centres were retrospectively reviewed. Twenty-three were primary procedures and 7 were ‘Rescue’ ones. Inclusion criteria were severe neurodisability, intractable gastroesophageal reflux, and dysphagia.

Results:

Preoperatively, all children had regurgitation, vomiting or retching, and 93% had unsafe swallowing and aspiration, with recurrent chest infections/aspiration pneumonia. Median relative weight was 77% (48%-118%). All patients were taking antireflux medication before surgery. Median age at TOGD was 6,48 years (0.69 - 22.18). Median follow-up was 3,5 years (0,6–17,7). No recurrence of GER and vomiting was recorded. The number of chest infections and length of hospital stay showed a significative decrease (p value