Esophagogastric disconnection following failed fundoplication for the treatment of gastroesophageal reflux disease (GERD) in children with severe neurological impairment.
This report describes our experience with esophagogastric disconnection and Roux-en-Y esophagojejunostomy for the treatment of gastroesophageal reflux disease (GERD) in seven neurologically impaired children as a second antireflux operation following failed Nissen fundoplication. After a mean follow-up of 3 years, three children (43%) were completely or almost completely symptom-free and had improved nutritional status. Early complications occurred in three patients (43%): small bowel obstruction, wound infection, and necrosis of the Roux-en-Y loop. Three patients (43%) presented long-term complications: jejunoesophageal bile reflux and bile reflux with gastric irritation. Two patients required reoperation (28%), and two deaths occurred in the postoperative period (28%). In three previous reports in the surgical literature, severe postoperative complications occurred in 0-44%, requiring reoperation in 0-22% of the patients, and the mortality rate was 0-11%. Esophagogastric disconnection for the treatment of GERD in neurologically impaired children is associated with major complications and should be considered after more conservative procedures fail.
Buratti
Silvia
S
Division of Pediatric Gastroenterology and Nutrition, University of California San Diego and Children's Hospital, 200 West Arbor Drive, San Diego, CA 92103-8450, USA.
Kamenwa
Rose
R
Dohil
Ranjan
R
Collins
David
D
Lavine
Joel E
JE
D000293:Adolescent; D000713:Anastomosis, Roux-en-Y; D001655:Bile Reflux / Q000209:etiology; D001927:Brain Diseases / Q000150:complications*; D002423:Cause of Death; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005756:Gastritis / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000209:etiology; D007421:Intestine, Small / Q000473:pathology; D007583:Jejunum / Q000601:surgery; D008297:Male; D009752:Nutritional Status; D011183:Postoperative Complications; D012086:Reoperation; D013270:Stomach / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology