Esophagogastric dissociation in the neurologically impaired: an alternative to fundoplication?
OBJECTIVE
Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD) is an alternative procedure for treatment of gastroesophageal reflux. The aim of this study is to evaluate the results of EGD in our institution and compare them with a neurologically matched group of children who had Nissen fundoplication.


METHODS
Twenty consecutive patients who had EGD were retrospectively evaluated and the results were compared with a neurologically matched group of 20 consecutive patients who had Nissen fundoplication.


RESULTS
Twenty patients had EGD, 17 as a primary procedure. There was no operative mortality but 5 have died of other causes. Resolution of reflux-associated symptoms occurred in all patients. Of the 15 survivors, 5 remain on antireflux medication. Twenty patients had fundoplication. There was no operative mortality, but 8 patients have died of other causes. Failure occurred in 5 patients necessitating further surgery. Of the 10 unreoperated survivors, 6 remain on antireflux medication.


CONCLUSIONS
Esophagogastric dissociation is an effective antireflux procedure when compared with fundoplication. It has a lower failure rate. We recommend EGD as a primary procedure in selected children with severe neurological impairment.
Department of Paediatric Surgery, Royal Liverpool Children's Hospital, Alder Hey, L12 2AP Liverpool, UK. dranjugoyal@yahoo.com
Anju
A
Goyal
Basem
B
Khalil
Kelvin
K
Choo
Khalid
K
Mohammed
Matthew
M
Jones
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D012189:Retrospective Studies; D016896:Treatment Outcome